Benefits, Health Care Reform

2017 4th Quarter Deadlines and Reminders for Group Health Plans

This is Leavitt’s Quarterly Update of Deadlines and Reminders in the upcoming quarter, for group health plans and sponsors. This is for fourth quarter of 2017. (Amended October 11 to add TRF second payment to November 15th date.)

September 30Date by which insurers must pay Medical Loss Ratio (MLR) rebates to policyholders, for the 2016 reporting year.  Employers who sponsor ERISA plans and who receive MLR rebates that are in part “plan assets” must pay the appropriate rebate amount to participants or for benefit improvements within three months of receipt of the MLR rebate from the carrier, or must establish a trust to hold the rebate as plan assets.

October 15 – Medicare Part D notice –  Date by which plan sponsors must send Medicare Part D notices to Medicare-eligible participants, informing them whether employer-sponsored prescription drug coverage is creditable or non-creditable. If employer sent notices earlier this year, not required to resend them.

October 31 – Plan sponsors of self-funded group health plans and/or IRC 125 plans may wish to have nondiscrimination testing done, so plan sponsor can make adjustments (if needed) before year-end.  (This is a suggested date, not a required date. Section 125 regulations require that nondiscrimination testing be done on the last day of the plan year.)

November 1  – Open enrollment begins in the Health Insurance Marketplaces (Exchanges).  Eligible individuals can enroll or renew enrollment for 2018, and some may qualify for subsidies.  Open enrollment period is November 1, 2017 – December 15, 2017.

November 15 –  Second portion of 2016 transitional reinsurance fee (TRF) is due, for self-funded health plans that submitted enrollment data to Pay.gov last year and paid only the first payment ($21.60 per enrollee) as of January 16, 2017. The second portion is $5.40 per enrollee, and it must be paid using an Automatic Clearing House (AHC) debit on Pay.gov. Employers should remove the AHC Debit Block to ensure the bank does not block the AHC debit. To do this, add Agency Location Code (ALC+2 value) 7505008016 (USDEPTHHSCMS) to your list of approved companies for AHC automatic debits, or make sure this is already on your list. Also, make sure there are sufficient funds in your account to pay the TRF.

The TRF was in effect from 2014-2016, so there is no 2017 TRF to schedule this November. Total TRF for 2016 was $27 per enrollee. For transitional reinsurance payments for 2016, see https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/The-Transitional-Reinsurance-Program/2016-Benefit-Year-Page.html

November 15- December 15 –  Special one-month enrollment period each year, during which small group health insurers must offer and write new coverage for small employers who do not meet the insurer’s minimum participation requirements.  Insurers are not required to renew existing plans that do not meet minimum participation rules, although apparently insurers generally do apply this to renewals to avoid having to swap their current small groups with other insurers.

December 15 – Date by which SARs (Summary Annual Reports)  – Plan administrator must distribute SARs to plan participants, if 5500 was filed October 15 (on extension).

December 15  Date by which individuals must enroll in Marketplace/Exchange coverage for it to be effective January 1, 2018.

December 30   Date by which ERISA plan sponsors who received MLR rebates on September 30 must pay the appropriate rebate amount to participants or for benefit improvements if the rebate is in part “plan assets,” or employer must establish a trust to hold the rebate as plan assets.

December 31 – Section 125 regulations require that nondiscrimination testing be done on the last day of the plan year, which is December 31 for calendar-year plans. Many employers test around October 31 so they can make any necessary adjustments and then do not re-test again on December 31. If IRS subsequently audited and questioned compliance, employer might need to re-run the test as of December 31 to prove plan complied with nondiscrimination requirements on that date.

December 31Date by which employers who sponsor self-funded plans must make third request for Social Security numbers of enrolled dependents, if they made the initial request in 2016, and if they want to be able to show they made a “reasonable effort” to obtain Social Security numbers, so they will not be subject to penalties for failure to report a Social Security number.  Per IRS Notice 2015-68.   See Leavitt article at https://news.leavitt.com/health-care-reform/aca-reporting-new-procedures-to-request-social-security-numbers/ .  Employers who made initial request in late 2015 would have made third request by December 31 of 2016, so this is no longer applicable.

December 31   Just a reminder that, as of December 31, employers have all the information they need to calculate whether they are “applicable large employers” (ALEs) in 2018 – because 2018 status is based on number of employees each month in 2017. Also, ALEs (and small employers who sponsor self-funded group health plans) have all the data they need for 2017 information reporting (Forms 1094-B or C and 1095-B or -C).

December 31  – HAPPY NEW YEAR!

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