Employee Benefits Compliance

Q4 2016 Deadlines and Reminders for Group Health Plans

Reminders for 2016 Group Health Plans

This is Leavitt’s Quarterly Update of Deadlines and Reminders in the upcoming quarter. This is for fourth quarter of 2016.  (This post was updated on October 10th, to add a new item for Nov. 15-Dec. 15 and for Nov. 23rd; and was updated December 5th re: ACA 1557 compliance, now shown as of January 1, 2017 rather than October 17.)

September 30Date by which insurers must pay Medical Loss Ratio (MLR) rebates to policyholders, for the 2015 reporting year.  (Before 2015, 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 –  Date by which Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form should be available on Pay.gov.  Submission deadline is November 15, 2016. For more information, go to https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/The-Transitional-Reinsurance-Program/Reinsurance-Contributions.html (Section 1341 of the Affordable Care Act, ACA.)

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.

October 30 – 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.  (not a required date)

November 1  – Open enrollment begins in the Health Insurance Marketplaces (Exchanges).  Eligible individuals can enroll or renew enrollment for 2017, and some may qualify for subsidies.  Open enrollment period is November 1, 2016 – January 31, 2017.

November 7  – Date by which group health plans WERE going to be required to use unique Health Plan Identifiers (HPIDs) in specified HIPAA standard transactions.  However, on October 31, 2014, HHS indefinitely delayed enforcement until further notice, and there has been no further notice at this time.  So the November 7, 2016 HPID requirement will NOT apply.

November 15 – Second portion of 2015 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 16, 2016. The second portion is $11.00 per enrollee.  The first portion was $33.00 per enrollee.  Total TRF for 2015 was $44 per enrollee.

November 15 –  For 2016 transitional reinsurance fee (TRF) calculation, deadline by which self-funded health plans must submit enrollment data to Pay.gov and schedule payment(s) to be made in 2017.  The 2016 TRF is $27 per enrollee, which can be paid either in one installment due by January 16, 2017, or in two installments, with $21.60 per enrollee due by January 16, 2017, and $5.40 per enrollee due by November 15, 2017.  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.

November 23 Date by which many group health plan sponsors should send participants either a new copy of the plan’s Notice of Privacy Practices or a notice informing them of their right to receive a Privacy Notice every three  years.  Since all group health plans were required to revise their Privacy Notices by November 23, 2013, for those that did so the three-year deadline will be November 23, 2016.

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, 2017.

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 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 2015, 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/ .

January 1, 2017 – Just a forewarning, since many plan sponsors have received notices from their carriers or TPAs:  By the first day of the 2017 plan yearaffected health programs must comply with OCR Final Rule on Nondiscrimination in Health Programs under section 1557 of the Affordable Care Act.  Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, gender identity, age and disability.  An issue for many employers is that plans subject to 1557 must cover sex-change operations and medical services.  If an insurer receives funding from HHS for its products offered on the Exchange or elsewhere, ALL of its health insurance products must comply with 1557.  So this will affect many insured employer group health plans.  For self-insured health plan, ACA 1557 applies only if the employer plan sponsor receives federal funding from HHS; however, it does not require self-funded group health plans to comply merely because their outside TPA must comply because it receives HHS funding.