The primary reasons employers implement a self-funded medical plan are to gain more control over plan design and avoid taxes, fees and insurance company profits, among other things. If you are self-funded today, you know that there is a never-ending supply of strategies to pursue in order to reduce costs. But, do the issues below sound familiar?Read More
Small Groups - Self-Funded Options
This is an historic time and we've almost reached a state of constant evolution in the benefits world due to health care reform. Business owners, and the professionals they've hired to help them manage benefits, are finding it almost impossible to keep up with the many changes of the Affordable Care Act.
The month of November brought a new delay in reporting required from self-funded plans. It also brought several new notices and regulations that may affect sponsors of group health plans and an updated employer guide and health plan compliance checklist from the Department of Labor (DOL).
To meet federal requirements, large health plans must obtain a national health plan identifier number (HPID) by November 5, 2014. For this requirement, a large health plan is one with more than $5 million in annual receipts.
The following is a summary of draft forms. Some of this information may change when final forms, and the instructions, are released.
In order for the IRS to verify that individuals and employers are meeting their shared responsibility obligations, and that individuals who request premium tax credits are entitled to them, employers and insurers will be required to provide reporting on the health coverage they offer. Reporting will first be due early in 2016, based on coverage in 2015.
To meet federal requirements large health plans must obtain a national health plan identifier number (HPID) by November 5, 2014. For this requirement, a large health plan is one with more than $5 million in annual receipts. The Department of Health and Human Services (HHS) has said that since health plans don't have receipts, insured plans should look at premiums for the prior plan year and self-funded plans should look at claims paid for the prior plan year. Small health plans have until November 5, 2015, to obtain an HPID.
On February 10, 2014, the IRS issued final regulations on the PPACA employer shared responsibility requirements. The requirements, often referred to as "Play or Pay" were to take effect in 2014. However, the White House announced on July 2, 2013 that compliance would be delayed until 2015.
With the PPACA changes have come a fundamental shift at many companies in the relationship between employers and employees around the issue of healthcare. Now that many companies are responsible for funding healthcare costs for their own employees, it is becoming more important than ever to consider implementing some new programs that will optimize the situation by encouraging employees to pay more attention to healthcare measures.
PPACA brings numerous responsibilities and options to employers. Below is a summary of the PPACA provisions that apply to group health plans and whether the provision applies to self-funded plans.