All group medical plans Plans and carriers may not enter into an agreement with a provider, network, TPA or other service provider offering access to a network of providers that restricts the plan from; providing provider-specific cost or quality of care data, electronically access de-identified claim and encounter data for each participant or beneficiary and […]
Employers with Self-funded/Level-Funded health plans This rule prohibits group health plans from discriminating in favor of highly compensated individuals with respect to both eligibility and benefits offered under the plan. Employers should review their plans and ensure plans are still within compliance and not discriminating against non-Highly Compensated Individuals (HCIs). HCIs must include the excess […]
Employers with Self-funded/Level-Funded health plans Plan is ultimately responsible for updating three machine readable files (MRFs) disclosing: in-network rates, OON allowed amounts, billed charges, negotiated rates and historical net prices for Rx drugs. Employers should collaborate with a third-party administrator to ensure the plan is administered in accordance with the TiC rules at each renewal. […]
For the 4th quarter of the previous calendar year.
Employers that filed 250 or more IRS Forms W-2 for the prior calendar year must include the aggregate cost of employer-sponsored health plan coverage on employees’ Forms W-2. This reporting is optional for employers that had to file fewer than 250 Forms W-2 for the prior calendar year. Employers must file Forms W-2 with the […]
Notice is required within the first 60 days of the plan year. Filing is made online at: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/CreditableCoverage/CCDisclosureForm.html More detail on creditable/non-creditable coverage is included in the discussion of the notices to participants by October 15.
Every person that provides minimum essential coverage to an individual during a calendar year must file an information return reporting the coverage. Insurers generally use Form 1094- B (transmittal) to submit Forms 1095-B (returns) to the IRS. However, self-funded employers (including governmental employers) subject to the employer shared responsibility provisions generally will report information about […]
Applicable Large Employers (i.e. those that are subject to the employer mandate) must report on the coverage offerings for each ‘full-time employee’ from the previous calendar year. Self-funded employers (of any size) are required to report on coverage provided to any employee in the prior calendar year. For more information, see: https://www.irs.gov/uac/About-Form-1095-B and https://www.irs.gov/forms-pubs/about-form-1095-c
