Employee Benefits Compliance, Transitional Reinsurance Fee

2015 Fourth Quarter Deadlines and Reminders



This is Leavitt’s Quarterly Update of Deadlines and Reminders in the upcoming quarter. This is for 4th quarter of 2015.

September 30 Date by which insurers must pay Medical Loss Ratio (MLR) rebates to policyholders, for the 2014 reporting year. Prior to this year, the date was August 1. 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 90 days of receipt of the MLR rebate from the carrier, or must establish a trust to hold the rebate as plan assets.

October 1 Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form available on Pay.gov. Submission deadline is November 16, 2015. For more information, go to https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/The-Transitional-Reinsurance-Program/Reinsurance-Contributions.html

October 15 – Medicare Part D notice –  plan sponsor must send to Medicare-eligible participants. See Leavitt article at https://news.leavitt.com/health-care-reform/send-medicare-part-d-notices-by-october-15-2015-employer-action-required/

October 30 – Recommended nondiscrimination testing (125 or self-funded plan) – so plan sponsor can make adjustments (if needed) before year-end.

November 1  – Open enrollment begins in the Health Insurance Marketplaces (Exchanges).  Eligible individuals can enroll or renew enrollment for 2016, and some may qualify for subsidies. Open enrollment period is November 1, 2015 – January 31, 2016.

November 16 – Second portion of 2014 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 as of January 15, 2015. The second portion is $10.50 per enrollee. The first portion was $52.50 per enrollee. Total TRF for 2014 was $63 per enrollee.

November 16 – For 2015 transitional reinsurance fee (TRF) calculation, deadline by which self-funded health plans must submit enrollment data to Pay.gov. The 2015 TRF is $44 per enrollee, which can be paid either in one installment due by January 15, 2016, or in two installments, with $33 per enrollee due by January 15, 2016, and $11 per enrollee due by November 15, 2016.

December 15 – 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, 2016.

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  Last day that “grandmothered” (i.e., non-PPACA compliant) California small group insured plans can operate. As of January 1, 2016, all small group insured plans must comply with PPACA rules, such as those on composite rating, covering all “essential health benefits,” no pre-existing conditions limitations on participants of any age. (This is per CA SB 1446. See Leavitt article on this at https://news.leavitt.com/health-care-reform/new-california-law-allows-renewal-2015-small-group-non-ppaca-compliant-plans/ ) But note that employers with 51-100 employees can renew in the large group market as late as December 1, 2015, and continue coverage under such policies through November 30, 2016.

Additional Detail on some of the above

OCTOBER 15, 2015 – Medicare D notice

Group health plan sponsors must provide Medicare Part D “creditable coverage” notices prior to October 15th, the start date of the Medicare annual enrollment period for Part D, Prescription Drug coverage. (The enrollment period is October 15-December 7.) Most plan sponsors use the Model Medicare Part D Notices provided by the Centers for Medicare and Medicaid Services (CMS) to notify affected plan participants. Links to all the model letters (in English and Spanish) are available here.  The requirement to provide Medicare part D notices applies to plan sponsors of insured, self-funded, large and small plans.

NOVEMBER 16, 2015 – Transitional Reinsurance Fee

The reinsurance fee is tax-deductible as an ordinary business expense.  For fully-insured plans, this fee will be paid by insurers and added onto the rates; self-funded plans are responsible for the fee.

Self-funded health plans must submit enrollment data to www.Pay.gov  for 2015 transitional reinsurance fee (TRF) calculation.  This is based on January through September data, even for non-calendar-year plans. The form will automatically calculate the reinsurance contribution amount due.  The plan or TPA also must submit payment information and schedule a payment date for remittance of the contributions.