Credible Coverage Disclosure to the Centers for Medicare and Medicaid Services (CMS)
Wellness Plan Incentive Limits Removed by EEOC
It’s That Time of the Year Again for ACA Reporting
Credible Coverage Disclosure to the Centers for Medicare and Medicaid Services (CMS)
Under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), group health plans that currently provide prescription drug coverage to Medicare Part D eligible individuals have two annual disclosure obligations. First, the Centers for Medicare & Medicaid Services (CMS) requires entities to provide a notice to all Medicare Part D eligible individuals disclosing whether the entities’ prescription drug coverage is “creditable,” i.e., whether the prescription drug coverage is equal to or better than the drug coverage offered under Medicare Part D. The deadline for providing the disclosure notices to Part D eligible individuals was October 15, 2018. Second, under the MMA, entities are also obligated to advise CMS as to whether or not the entities’ prescription drug coverage is “creditable.”
A. Timing of Disclosure Notice to CMS
The deadline for notifying CMS as to whether an entity’s coverage is “creditable prescription drug coverage” is sixty (60) days after the beginning of the plan year. For 2019 calendar year plans, the deadline is March 1, 2019. Disclosure to CMS must also be made within 30 days after any change in the “creditable” coverage status of any prescription drug coverage.
B. Manner of Disclosure Notice to CMS
A plan is required to provide the Disclosure to CMS Form (“Disclosure Form”) through completion of the form on-line at the CMS Creditable Coverage Disclosure Web Page at:
https://www.cms.gov/Medicare/Prescription-Drug-Coverage/CreditableCoverage/CCDisclosureForm.html
This is the sole method for complying with the CMS disclosure requirement. The following plans that provide prescription drug coverage to Medicare Part D eligible individuals are required to go on-line and complete the required Disclosure Form by the deadline indicated above:
This is the sole method for complying with the CMS disclosure requirement. The following plans that provide prescription drug coverage to Medicare Part D eligible individuals are required to go on-line and complete the required Disclosure Form by the deadline indicated above:
- Group health plans offered by employers.
- Taft-Hartley plans.
- Church Plans.
- Federal, State, and Local government plans.
IMPORTANT NOTE: If your plan already applied for the Retiree Drug Subsidy Program, you are not required to submit the on-line Disclosure Form to CMS, as CMS has deemed your application as in full compliance with this disclosure obligation.
C. Content of Disclosure Notice to CMS
CMS requires certain information be made available to it relating to this disclosure obligation, including but not limited to, the name of the entity offering prescription drug coverage; the address, phone number and Federal Tax Identification Number of the entity; type of coverage being offered; the number of Part D eligible Individuals expected to be covered under the plan; the date the Notice of Creditable Coverage was provided to Part D eligible individuals; and the name, title, and email address of the entity’s authorized individual.
WHAT YOU NEED TO DO
- Print the Helpful Tips When Completing On-Line Disclosure to CMS.
- Go on-line and complete the Disclosure Form to CMS by March 1, 2019 (for 2019 calendar year plans).
Please do not hesitate to contact your Allied Account Executive or Allied Account Manager should you have any questions or need assistance.
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- The Name of Entity shoold be the name of the Employer sponsoring the plan.
- Use the Federal Tax ID Number listed in your Plan Document/SPD.
- Under “Coverage Type”, choose only one sub-category under the “Group Health Plan” choices. Please note that a group health plan may have a number of different options, coverages, etc. A separate on-line disclosure is not required to be completed.
- Under the Section “Creditable/Non-Creditable Offer,” choose one of the three choices available. For many of you, the choice will be “All Options Offered Are Creditable”. After you make your selection, additional information specific to your plan will be requested. You will be asked to provide the flilowing:
- The beginning and ending date for your Plan Year. Examples: A plan that runs on a calendar year basis shoold use 01/01/2019 to 12/31/2019. A Plan Year that begins February 1st shoold use 02/01/2019 to 01/31/2020.
- You will be asked to provide the number of Part D Eligible Individuals expected to have prescription drug coverage under your plan. Please keep in mind that this only needs to be an estimate of the number of individuals covered under your plan that are 65 years of age or lider, or disabled individuals under the age of 65.
- You will also be asked to provide the number of Retirees covered under your plan who are Part D Eligible Individuals. If you do not provide any retiree coverage, please enter “0”. For those plans providing retiree coverage, you only need to provide an estimate of the number of retirees covered under your plan who are Part D Eligible Individuals.
- You need to provide the date that you sent/provided the notice of creditable coverage to all participants or to the participants over the age of 65. For many of you, please note that this date shoold be prior to October 15, 2018. For groups in which Allied mailed the notices on behalf of your plan, please enter 10/10/2018.
- Please choose “yes” or “no” when asked whether your creditable coverage status changed from the last plan year. If you choose “yes,” you must provide 1) the effective date of this change, and 2) the date you disclosed to Medicare Part D Eligible Individuals about this change.
- Lastly, you will be asked for the name, title and email address of the entity’s Authorized Individual. This means the person employed by the entity that is completing the on-line Disclosure Form. Then fill in the date and click “Review and Submit.” After you click “Submit,” you shoold see the flilowing message: Success! Your form has been successfolly submitted.
Additional information relating to the on-line Disclosure Form can be found at https://www.cms.gov/CreditableCoverage.
Wellness Plan Incentive Limits Removed by EEOC
On Dec. 20, 2018, the Equal Employment Opportunity Commission (EEOC) removed the incentive limits from its final wellness plan rules. The rules allowed employers to offer wellness incentives of up to 30 percent of the cost of health plan coverage.
The AARP successfully challenged the EEOC’s incentive limit by arguing that it was too high to be consistent with federal laws that require “voluntary” employee participation in wellness programs. The court vacated the EEOC’s incentive limit for employer-sponsored wellness plans, effective Jan. 1, 2019.
Beginning Jan. 1, 2019, the final rules’ guidance on permissible incentive limits for voluntary wellness programs no longer applies.
Due to this new legal uncertainty, employers should carefully consider the level of incentives they use with their wellness programs. Employers should also monitor any developments related to the EEOC’s rules. Contact us today for more information.
It’s That Time of the Year Again for ACA Reporting
The Affordable Care Act (ACA) created reporting rules under Code Sections 6055 and 6056 that require certain employers to provide information to the IRS about the health plan coverage they offer (or do not offer) or provide to their employees. Each reporting entity must annually file all of the following with the IRS:
- A separate statement (Form 1095-B or Form 1095-C) for each individual who is provided with minimum essential coverage (for providers reporting under Section 6055), or for each full-time employee (for ALEs reporting under Section 6056)
- A transmittal form (Form 1094-B or Form 1094-C) for all of the returns filed for a given calendar year
Reporting entities must also furnish related statements (Form 1095-B or 1095-C) to individuals.
The final forms for 2018 have been published, which means it’s time for you to take action. Fortunately, the 2018 forms and instructions are substantially similar to the 2017 versions. The most significant change is that Form 1095-C clarifies that the “Plan Start Month” box in Part II will remain optional for 2018. The IRS previously indicated that this box may have been mandatory for the 2018 Form 1095-C.
These forms must be filed with the IRS no later than Feb. 28, 2019 (April 1, 2019, if filing electronically). However, the IRS extended the due date for furnishing individual statements for 2018 an extra 30 days, from Jan. 31, 2019, to March 4, 2019.
Please contact us today to get assistance with ACA reporting or to request employee communications on this topic.
