Prohibition on Gag Clauses
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 […]
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Section 105(h) Nondiscrimination Testing
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. […]
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TiC: Machine- Readable Files
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 […]
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Quarterly Report Deadline
For the 4th quarter of the previous calendar year.
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Reporting health plan costs on Form W-2 Deadline
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 […]
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Submit Annual Notice of Creditable and/or Non-Creditable Coverage to CMS
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 […]
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IRS Form 1094/95 – B & C paper filing due- February 28 deadline for 2025
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 […]
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Deadline for providing Forms 1095-B/C to Employees
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 […]
