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Vedder Thinking | Articles Health Care Reform: Upcoming Key Dates for Employer-Sponsored Health Plans

Newsletter/Bulletin

The following is a list of some key dates for employers that provide group health benefits to their employees. Some of the requirements were created by the Patient Protection and Affordable Care Act (the "ACA") and are new or relatively new; other compliance obligations listed have been in place for years or more.

The list below is based upon dates for plans that are operated on a calendar year basis. Certain dates listed will be different for non-calendar year plans.

September 2014

Finalize eligibility rule changes for ACA employer mandate compliance

Employers with 100 or more full-time employees should finalize assessment of any eligibility changes and employee premium rates for purposes of ACA employer shared responsibility provisions. Beginning in 2015, those employers are subject to the penalties under the ACA's "play or pay" mandate. For more information, see our bulletin "IRS Final Rule on ACA Play or Pay Mandate Allows Employers to Finalize Compliance Plans" (February 19, 2014).

Complete updating of business associate agreements

Confirm that business associate agreements have been updated to comply with final regulations issued in 2013 under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (the HITECH Act). The deadline reflects the 12-month extension previously granted. See our bulletins "HIPAA Omnibus Final Rule: Highlights for Business Associates" (February 22, 2013) and "Key Effects of the Newly Published HIPAA Omnibus Final Rule" (January 30, 2013).

October 2014

Update plan documents to reflect eligibility changes

Incorporate any changes in definition of eligible employees into plan documents, summary plan descriptions, open enrollment materials, employee handbooks and other documents describing which employees are eligible to participate.

Update enrollment forms

Update enrollment forms used in open enrollment for mid-year hires and for changes in status to include a request for a taxpayer identification number (TIN) for each dependent. This is needed for the new informational reporting requirements under Internal Revenue Code Sections 6055 and 6056. See our bulletin "Health Care Reform: ACA Employer Information Reporting Requirements for Employers."

Finalize plans for identifying "full-time employees"

Applicable large employers (those with 50 or more full-time employees) should be finalizing plans for identifying employees who will be treated as "full-time employees" for purposes of the ACA's employer shared responsibility provisions. This will include implementing procedures for measuring hours of service and determining if a monthly approach or a look-back measurement period approach will be used for variable-hour and/or seasonal employees. If a look-back measurement period approach is used, the standard measurement period will need to be established, as well as other specifics. For example, employers with calendar year plans using a look-back period approach will generally use a standard measurement period that begins and ends in October of each year, followed by an administrative period ending December 31, during which variable-hour and seasonal employees who earned at least 1,560 hours of service during the standard measurement period will be given an opportunity to enroll for the following plan year. For more information, see our bulletins "IRS Final Rule on ACA Play or Pay Mandate Allows Employers to Finalize Compliance Plans" (February 19, 2014), and "Health Care Reform: Employer Shared Responsibility Requirements Require Action" (February 4, 2013).

Distribute Medicare Part D Notice

Medicare Part D Notice of Creditable Coverage or Non-Creditable Coverage must be furnished before October 15 to all covered persons who are eligible for Medicare. This is an annual obligation that predates the enactment of the ACA.

File 5500 annual report

October 15 is the deadline for the 2013 IRS Form 5500 for calendar year plans that filed a timely request for an extension of time using IRS Form 5558.

Prepare for ACA informational reporting obligations

Compliance with the ACA's new informational reporting obligations associated with the individual and employer mandate should be worked on. Initial steps include reviewing payroll and HRIS recordkeeping systems to ensure that necessary data elements may be captured. See our bulletin "Health Care Reform: ACA Employer Information Reporting Requirements for Employers" for more information.

Obtain health plan identification number

Employers with large self-insured health care plans should begin the process of obtaining a health care plan identification number (HPID), required by HIPAA, so that the process can be completed by the November 5, 2014 deadline. HPIDs are issued by the Centers for Medicare and Medicaid Services (CMS). Click here to begin the process. Small plans (those with less than $5 million in annual claims) have an additional year, until November 5, 2015, to secure an HPID. It appears that insurers generally will be obtaining HPIDs for insured plans.

November 2014

Transitional Reinsurance Program filing due

November 15 is the deadline to electronically submit through www.Pay.gov the 2014 enrollment count and documentation and schedule reinsurance payments for the ACA Transitional Reinsurance Program. This annual fee for 2014 may be paid as a single installment by January 15, 2015, or in two installments. The rate for 2014 is $63 per year per covered life ($5.25 per month), and for 2015 it will be $44 per year ($3.67 per month). Insurers are responsible for paying the fee for insured plans. For self-insured plans, the employer is responsible for paying the fee, although arrangements may be made for the plan's third-party administrator to pay the fee on the plan's behalf.

Include required notices with open enrollment materials

Include in open enrollment materials a summary of benefits and coverage (SBC) for each health care benefits option. If the plan or a plan option is grandfathered, the open enrollment materials should also include a notice of the plan's continued grandfathered status. Consider also including with open enrollment materials other notices required to be furnished annually, including notices required under the Women's Health and Cancer Rights Act (WHCRA) and the Children's Health Insurance Program (CHIP). Note that the Department of Labor issued an updated model CHIP notice earlier this year that should be used. The updated notice includes information on the new health care insurance Marketplaces, also known as Exchanges, established by the ACA.

Ensure a record of each offer of coverage is maintained

For purposes of demonstrating compliance with the ACA's employer shared responsibility provisions, applicable large employers should ensure that a written record is maintained of all offers of coverage as part of the annual enrollment process, as well as in connection with mid-year hires and changes to benefits eligible status. This is because the potential penalties under the ACA's employer shared responsibility provisions are based upon whether an employer "offered its full-time employees (and their dependents) the opportunity to enroll" in minimum essential coverage. On audit, the government is expected to require proof that an offer of coverage was made.

SHOP exchanges open for small employers

Federally facilitated Small Business Health Options Program (FF-SHOP) for small employers to purchase group coverage through Healthcare.gov is scheduled to launch November 15. Early access prior to that date is currently planned for the following states: Delaware, Illinois, New Jersey, Missouri and Ohio. This provides an alternative forum in which smaller employers – generally those with fewer than 100 employees – may shop for group health care insurance coverage.

December 2014

Distribute summary annual report

December 15 is the deadline for furnishing to participants the 2013 summary annual report (SAR) for calendar year plans filing their Form 5500 annual report under the extended deadline of October 15.

Finalize informational reporting data collection plans

By the end of December, employers should have finalized plans to collect for 2015 data required for IRS informational reports and returns under Code Sections 6055 and 6056. See our bulletin "Healthcare Reform: ACA Employer Information Reporting Requirements for Employers" for more information.

Finalize FSA $2500 annual limit amendment

December 31 is the deadline for adopting the required amendment limiting health care flexible spending account annual contributions to $2,500. This ACA limitation became effective January 1, 2013, for calendar-year plans, but the IRS has allowed employers until the end of 2014 to adopt the required conforming amendment.

January 2015

Employer shared responsibility provisions effective

ACA employer shared responsibility provisions become effective January 1, 2015, for calendar-year plans based upon one-year delay in enforcement announced in July 2013. See our bulletin, "IRS Final Rule on ACA Play or Pay Mandate Allows Employers to Finalize Compliance Plans," (February 19, 2014).

Pay Transitional Reinsurance Program fee

Payment of the ACA Transitional Reinsurance Program fee is due. For additional information, see the November entry above on this subject.

Include coverage information on Form W-2

The Forms W-2 issued to employees must include the aggregate cost of applicable employer-sponsored health care insurance coverage. This requirement was first effective for the 2012 Form W-2 issued in January 2013. An exception remains in effect for smaller employers that issued fewer than 250 Forms W-2 for the preceding year.

March – June 2015

Conduct ACA employer shared responsibility reassessment

Large employers with 100 or more full-time employees should conduct a detailed analysis of whether any further changes should be made in plan eligibility rules to satisfy the 95 percent threshold in 2016 (up from 70 percent in 2015) under the ACA's employer shared responsibility provisions. Employers with 50 to 99 full-time employees who previously qualified for transition relief from the ACA employer shared responsibility provisions should finalize assessment of any eligibility changes and employee premium rates, for purposes of the ACA employer shared responsibility provisions. Beginning in 2016, those employers are subject to the penalties under the ACA's "play or pay" mandate. For more information, see our bulletin "IRS Final Rule on ACA Play or Pay Mandate Allows Employers to Finalize Compliance Plans" (February 19, 2014).

July 2015

PCORI fee due

July 31 is the annual deadline for payment of the Patient Centered Outcomes Research Institute fee (PCORI fee) of $2 per covered life for the preceding plan year. For more information, see our bulletin "Healthcare Reform Requires Action" (September 2013).

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The legal landscape for employer-provided health care benefits has become significantly more complex in recent years. If you have any questions about the foregoing or any other health care plan compliance issues, please contact Thomas G. Hancuch +1 (312) 609 7824 or any other Vedder Price attorney with whom you have worked.



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