Under the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), employers that offer prescription drug coverage on a group basis are required to provide annual notice to both employees/covered individuals and to the Centers for Medicare & Medicaid Services (CMS) regarding the “creditability” of the prescription coverage offered by the employer (whether or not the prescription coverage is equal to or exceeds the value of prescription coverage through Medicare Part D).
The employee/covered individual notice must be provided at least annually to those Medicare Part D eligible individuals who are covered by, or who apply for, prescription drug coverage under the group health plan. To simplify plan administration, plan sponsors often decide to provide the disclosure notice to all plan participants.
At a minimum, this notice must be provided at the following times:
1. Prior to the Medicare Part D Annual Coordinated Election Period – Oct. 15 through Dec. 7 of each year;
2. Prior to an individual’s Initial Enrollment Period for Part D;
3. Prior to the effective date of coverage for any Medicare eligible individual that joins the plan;
4. When prescription drug coverage ends or changes so that it is no longer creditable or becomes creditable; and
5. Upon a beneficiary’s request.
If the employer provides the notice annually prior to 10/15, items 1 and 2 are considered to be met.
The CMS disclosure notice must be made to CMS on an annual basis, or upon any change that affects whether the coverage is creditable. At a minimum, the notice must be provided at the following times:
1. Within 60 days after the beginning date of the plan year for which the entity is providing the form;
2. Within 30 days after the termination of the prescription drug plan; and
3. Within 30 days after any change in the creditable coverage status of the prescription drug plan.
If you have questions regarding the creditability status of your plan, creating notices specific to your plan, or the notification process, please contact your NEEBCo representative.
The Internal Revenue Service (IRS) released draft 2018 forms for reporting under Internal Revenue Code (Code) Sections 6055 and 6056. The draft 2018 forms are substantially similar to the final 2017 versions.
- 2018 draft Forms 1094-C and 1095-C were released July 11, 2018, and will be used by applicable large employers (ALEs) to report under Section 6056, as well as for combined Section 6055 and 6056 reporting by ALEs who sponsor self-insured plans.
- 2018 draft Form 1094-B was released July 3, 2018, and will be used by entities reporting under Section 6055, including self-insured plan sponsors that are not ALEs.
A 2018 draft version of Form 1095-B and draft instructions for these forms have not yet been released.
1095 Individual statements for 2018 must be furnished by Jan. 31, 2019. IRS returns for 2018 must be filed by Feb. 28, 2019 (April 1, 2019, if filed electronically, since March 31, 2019, is a Sunday).
As always, clients have available the NEEBCo Connect portal to complete their ACA reporting requirements. Contact your NEEBCo representative with questions.
Draft Forms for 2018 ACA Reporting Released 7-13-18
Through 2018, Harvard Pilgrim is offering online weight management and healthy eating programs with Gain Life for all fully insured accounts.
The programs are available to self-insured accounts for a fee.
Gain Life’s 16-week programs are personalized by gender and lifestyle, and they are available via smartphone, tablet or computer
See below for the employer and employee flyers, and contact your NEEBCo representative with additional questions.
HPHC Gain Life Employer Flyer
HPHC Gain Life Member Flyer
In many cases, when a prescription is purchased by a patient the prescription drug manufacturer pays a rebate to the pharmacy benefit manager (PBM), who then shares a portion of the rebate with the health insurer.
Effective January 1, 2019 Tufts Health Freedom Plan will pass pharmacy rebates directly to fully insured members on the high deductible Saver plan at the point of sale.
For self funded members, the rebates will be available as an option for the employer’s consideration.
The rebates will apply at the 60,000+ pharmacies in the CVS network.
Contact your NEEBCo representative with questions.
On June 19, 2018, the Department of Labor (DOL) released a final rule that gives small businesses more freedom to join together as a single group to purchase health insurance in the large group market or to self-insure. These benefit arrangements are called association health plans (AHPs). AHPs have been available to small employers, but the Final Rule offers new options.
AHPs are a type of multiple employer welfare arrangement (MEWA). Because AHPs are regulated at the federal and state level, the availability of these plans will also depend on a state’s regulatory approach. ERISA allows states to regulate MEWAs under their own insurance laws and regulations. For example, to guard against fraud and abuse, a number of states provide that self-insured MEWAs must be licensed, registered, have a minimum number of participating employers, obtain an actuarial opinion that the MEWA can meet promised benefits and keep a minimum level of reserves. Several states prohibit self-insured MEWAs altogether.
The final rule allows fully insured plans to begin operating under the new rule on Sept. 1, 2018. Existing self-insured AHPs can begin operating under the new rule on Jan. 1, 2019, and new self-insured AHPs can begin on April 1, 2019.
Refer to the below Compliance Bulletin and Fact Sheet for details and contact your NEEBCo representative with questions.
DOL Finalizes Rule to Expand Association Health Plans
AHP Fact Sheet
As of June 11, 2018, John Elias began his five year term as the new Commissioner of the New Hampshire Insurance Department, replacing Robert Sevigny after 16 years in the post. Commissioner Elias was nominated by Governor Chris T. Sununu and unanimously approved by the New Hampshire Executive Council in May.
“I am honored to be trusted with this responsibility,” said Commissioner John Elias. “I am excited to get started working in this new role on behalf of New Hampshire.”
Elias’s priorities as commissioner include regulatory modernization, operational efficiency and effectiveness in the pursuit of regulatory value, and the use of data to promote market transparency and to improve regulatory accountability and success in the reduction of public harms.
For the full press release, click here.
New Jersey became the second state to enact its own individual mandate penalty. On May 30, 2018, New Jersey Gov. Phil Murphy signed two bills into law that are designed to stabilize and reduce health insurance premiums in the individual market.
These new laws are among the first state laws passed in response to changes made to the federal ACA. New Jersey is only the second state to enact its own health insurance individual mandate.
To help administer the individual mandate penalty, the New Jersey Health Insurance Market Preservation Act imposes a reporting requirement on every entity that provides MEC to an individual during a calendar year, similar to the ACA’s reporting requirement under Internal Revenue Code Section 6055.
Refer to the below bulletin for additional information and contact your NEEBCo representative with questions.
New Jersey Enacts State Individual Mandate and Reinsurance Program
Every three years, the DOL must submit its model FMLA forms to the federal Office of Management and Budget (OMB) for approval for continued use. The OMB’s approval for the current FMLA forms expires in 2018. This expiration date is included on the model forms in the upper right corner.
The DOL has requested that the OMB reauthorize the model FMLA forms for another three-year period, until 2021, without proposing any substantive changes to the forms.
Employers may continue to use the DOL’s current model forms until new ones are released. The updated model forms are expected to be the same as the current forms, except they will have a 2021 expiration date in the upper right corner.
Employers that use the model FMLA forms can monitor the DOL’s FMLA webpage for updated model forms.
Refer to the below Compliance Bulletin for additional information and contact your NEEBCo representative with questions.
DOL’s FMLA Forms Expire in 2018
For plan years beginning in 2019, employer-sponsored coverage will be considered affordable if the employee’s required contribution for self-only coverage does not exceed:
- 9.86% of the employee’s household income for the year, for purposes of both the pay or play rules and premium tax credit eligibility; and
- 8.3% of the employee’s household income for the year, for purposes of an individual mandate exemption (adjusted under separate guidance).
These updated affordability percentages are effective for taxable years and plan years beginning Jan. 1, 2019. This is an increase from the affordability contribution percentages for 2018. As a result, some employers may have additional flexibility with respect to their employee contributions for 2019 to meet the adjusted percentage.
Refer to the below Compliance Bulletin for details and contact your NEEBCo representative with questions.
Affordability Percentages Will Increase for 2019
On May 10, 2018, the IRS released Revenue Procedure 2018-30 to announce the inflation-adjusted limits for health savings accounts (HSAs) and high deductible health plans (HDHPs) for 2019.
The adjusted contribution limits for HSAs take effect as of Jan. 1, 2019. The adjusted HDHP cost-sharing limits (minimum deductible and maximum out-of-pocket) take effect for the plan year beginning on or after Jan. 1, 2019.
The following chart shows the HSA and HDHP limits for 2019 as compared to 2018. It also includes the catch-up contribution limit that applies to HSA-eligible individuals who are age 55 or older, which is not adjusted for inflation and stays the same from year to year.
Contact your NEEBCo representative with questions.
IRS Announces HSA Limits for 2019