Health & Welfare Notes
Vol. 19, Issue 4 September/October 2014
Reminder: Reporting Transitional Reinsurance Fee Enrollment Count is Due By November 15, 2014. Our July/August 2014 Health and Welfare Notes provided background information and highlights of the reporting requirements of the Affordable Care Act’s Transitional Reinsurance Program. The statute requires all health insurance issuers and plan sponsors of self‑insured group health plans (that offer major medical coverage) to make contributions under this program. As reported in late August, the “ACA Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form” was not yet available. This Form became available on Pay.gov on October 24, 2014. The deadline to register the 2014 benefit year’s enrollment count is November 15, 2014. The reinsurance contribution payment(s), however, are not due by that date but must be scheduled for payment by that date; payment options include: (1) the entire fee for 2014 can be made in one payment no later than January 15, 2015 reflecting $63.00 per covered life; or (2) in two separate payments: the first payment due by January 15, 2015 reflecting $52.50 per covered life; and the second payment due by November 15, 2015 reflecting $10.50 per covered life.
HHS has implemented a streamlined approach to complete the contributions (fee) process through Pay.gov. To successfully complete the reinsurance contribution process, contributing entities, or third party administrators or ASO contractors on their behalf, must register on Pay.gov. To find the “ACA Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form” on Pay.gov, type ACA in the search box. Although the Form is a simple-looking two page form, administrative effort will be required in order to provide the appropriate participant and dependent counts as well as the required supporting documentation. Each required step, however, is detailed in the Centers for Medicare & Medicaid Services (CMS) / Center for Consumer Information and Insurance Oversight (CCIIO) 60 page “ACA Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form Manual,” which can be found on the CMS website at cms.gov (type Reinsurance User Manual in the search box). The CMS Manual is clearly written and very easy to follow.
CMS/CCIIO also provides additional resources to support Reporting Entities in the creation of the required supporting documentation that is submitted (uploaded) with the Submission Form. These resources include the “ACA Transitional Reinsurance Program Supporting Documentation Job Aid Manual” and the “Job Aid Template” which is an MS Excel workbook that allows users to enter, validate and convert Contributing Entity information into a Comma Separated Value (CSV) file format. These resources can also be found on cms.gov (type Job Aid Manual or Job Aid Template in the search box).
Determining the average number of covered lives. As provided in earlier Health and Welfare Notes, there are four different counting methods permitted to determine the average number of covered lives (enrolled employees, dependents, retirees, and COBRA-qualified beneficiaries who are not also covered by Medicare). The counting methods are similar to the PCORI fee methods; however, the reinsurance fee count is based on the calendar year and not the plan year. The counting methods generally calculate covered lives based on enrollment in the first nine months of the calendar year, except if the Form 5500 counting method is used. Retiree major medical coverage is generally subject to the fee, but retiree coverage that pays secondary to Medicare is not subject to the fee. If a group health plan is paying health coverage for an individual which is secondary or supplemental to another group health plan for which reinsurance contributions are required, or for an individual who is also enrolled in individual market health insurance coverage for which reinsurance contributions would be required, the group health plan providing secondary or supplemental coverage would not have to pay reinsurance contributions for that person.
Federal Agencies Release Final Regulations on Excepted Benefits. The Departments of Treasury, Labor and Health and Human Services, which are responsible for implementing the Affordable Care Act (ACA), published a final rule on excepted benefit standards for limited-scope vision and dental benefits, as well as employee assistance programs (EAPs). Plans that satisfy these standards are exempt from mandates under HIPAA, ACA, and other federal laws, including the ban on annual or lifetime dollar limits. The final regulations give employers more flexibility in their EAPs and stand-alone limited-scope dental and vision programs. The final regulations are effective on December 1, and they apply to group health plans for plan years beginning on or after January 1, 2015.
The final rules largely follow the proposed regulations published in December 2013, with a few notable changes/enhancements:
- The final rules expand the definition of excepted benefits to include any self‑funded dental/vision benefits under which the claims for the benefits are administered under a contract separate from claims administration for any other benefits under the plan. Proposed regulations already provided that self‑funded dental/vision benefits would be excepted benefits if participants were permitted to opt‑out of those benefits.
- The final rules adopted the following four criteria for determining whether an EAP constitutes an excepted benefit:
- The EAP does not provide significant benefits in the nature of medical care.
- The EAP benefits cannot be coordinated with benefits under another group health plan. This means that participants in the other plan must not be required to use and exhaust the EAP benefits before becoming eligible for the other group health benefits, and eligibility for the EAP must not be dependent on participation in another group plan.
- No employee premiums or contributions may be required as a condition of participation in the EAP.
- The EAP may not impose any cost‑sharing requirements.
Notably, the preamble to the final rules states that treating wellness programs as excepted benefits by including them in an EAP would circumvent consumer protections contained in the ACA. Employers are hoping for additional guidance related to wellness programs.
- Additionally, the final rules do not address the limited wraparound coverage excepted benefit included in the proposed regulations because numerous comments were received on this issue which the Departments are still working through. They plan to publish further guidance in the future.
[Seyfarth Shaw LLP, Client Alerts, 10/27/2014; Towers Watson, Insider, October 23, 2014]
Disclaimer – This newsletter’s purpose is to inform our clients and colleagues of recent legislative health care-related developments. It is not intended, nor should it be used, as a substitute for specific legal advice.
Health and Welfare Notes is prepared four to six times annually and will accompany Retirement News. If there are questions concerning the information discussed, call richard Gabriel associates and ask for Gabe Zinni, Karen Irwin, Cindy Swartz or Nancy Cunningham.