Compliance Checklist for Health & Group Benefit Plans
September 23, 2014 through January 1, 2015
Written By Lori Wagner
This checklist is intended to help plan sponsors manage reporting and compliance deadlines in the ever-changing health benefits landscape. This list is not necessarily all-encompassing as each organization may have its own unique circumstances.
September 23, 2014 – Updated Business Associate Agreements (BAAs) for Existing Business Associates
All self-funded group benefit plans, as Covered Entities, must have an updated BAA with its current Business Associates that reflects Health Information Technology for Economic and Clinical Health (HITECH) changes and guidance from the Department of Health and Human Services (HHS) by no later than 9/23/2014.
September 24, 2014 – Non-Grandfathered Plan Benefit Change
Plan years beginning on or after September 24, 2014, non- grandfathered health plans must now cover breast cancer risk-reducing prescriptions with no cost sharing.
September 30, 2014 – Summary Annual Report (SAR) Deadline
Health & Welfare plans filing an Annual Form 5500 by July 31, 2014 must distribute the SAR to all plan participants by September 30, 2014.
October 15, 2014 - Medicare Part D Notice of Creditable Coverage
Plans that offer prescription drug coverage must disclose to all active and retired employees who are Medicare eligible in a notice as to whether that coverage is "creditable", i.e., equal or greater in value to the standard Medicare Part D coverage. In addition, an online disclosure to the Centers for Medicare & Medicaid Services (CMS) about the creditable coverage status of the drug benefit must be made no later than 90 days after the following plan year end.
November 5, 2014 – Health Plan Identifier Number
As a HIPAA covered entity, self-funded health plans with more than $5 million in annual claims must register for a Health Plan Identifier Number (HPID).
On September 24, the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) made available a quick reference guide that includes detailed steps on obtaining a controlling health plan HPID. Under the final rule, a self-funded customer needs to obtain its own HPID if it meets the definition of a controlling health plan (CHP).
A controlling health plan is a health plan that:
1. Controls its own business activities, actions, or policies; or is controlled by an entity that is not a health plan; and
2. If it has a sub-health plan(s) (SHP), exercises sufficient control over the sub-health plan(s) to direct its/their business activities, actions, or policies.
In addition, CMS has enhanced the functionality of its site, which will help employers and service providers determine whether or how to obtain an HPID.
November 15, 2014 - Transitional Reinsurance Program Fee
This fee applies to both insured and self-insured plans. Post-65 retiree coverage is excluded. Fees for 2014 are $63/member (per covered life including COBRA continuants). The plan sponsor must submit an enrollment count to the U.S. Department of Health and Human Services (HHS) by November 15 and HHS will calculate the fee and advise the plan on the amount due. The first installment of $52.50/member is due within 30 days and the second installment of $10.50 will be invoiced in 2015 and then payable within 30 days.
December 15, 2014 – Summary Annual Report (SAR) when Form 5500 extended
Health & Welfare Plans filing an Annual Form 5500 by October 15, 2014 must distribute the SAR to all plan participants by December 15, 2014.
December 31, 2014 – Health Care Flexible Spending Account (FSA)
A Health Care FSA with a 2.5 month grace period may adopt, beginning 1/1/2015, a carryover feature. The Plan may allow participants to carry over up to $500 of unused health FSA amounts remaining at the end of the plan year to reimburse qualified medical expenses incurred during the following plan year. Carryover does not count towards the $2,500 annual FSA limit.
January 1, 2015 – Employer Mandate (Pay or Play) under PPACA Becomes Effective
The Employer Shared Responsibility rules under the Patient Protection and Affordable Care Act (PPACA) becomes effective for employers with 100 or more full-time employees.
CAUTION – Employer Shared Responsibility transition relief for employers with 50 – 99 full-time equivalent employees does not excuse reporting under Code Sections 6055 and 6056.
Findley Davies can assist your organization to meet its compliance requirements under all of these deadlines. Our team of experienced professionals can:
• Assist with all aspects of HIPAA Privacy and Security rule compliance
• Prepare your 5500s and Summary Annual Report (SAR)
• Prepare Medicare Part D Notices of Creditable Coverage
• Complete the Medicare Part D on-line disclosure to the Centers for Medicare & Medicaid Services (CMS)
• Help you understand how to apply for the Health Plan Identifier Number (HPID) online
• Calculate the Transitional Reinsurance Fee and advise you on how to submit payment online
• Review and update Flexible Spending Account (FSA) Plan Documents and Summary Plan Descriptions (SPDs) if your organization has selected the carryover feature
• Prepare for the employer mandate and all other aspects of PPACA compliance