IRS Issues Guidance on Exceptions from Electronic Filing Requirements for Certain Filers of Forms 8955-SSA and 5500-EZ
Medicare Part D Notice to Employees Is Due October 14, 2023
Employers must notify individuals who are eligible to participate in their medical plan whether the plan's prescription drug coverage is "creditable" or "non-creditable" as compared to Medicare Part D coverage.
As a reminder, the Medicare Part D notice of creditable coverage should be distributed to employees by October 14, 2023. CMS provides a model notice for employers. The notice serves to inform Medicare-eligible individuals of whether or not their employer group coverage is creditable. This information can help such individuals avoid paying higher premiums (also known as late enrollment penalties) for Medicare Part D coverage.
Employers should consult with their service providers to determine whether their coverage is creditable using the simplified determination method or actuarial analysis.
For more information, please download Medicare Part D Disclosures: A Guide for Employers publication.
It’s MLR Rebate Time Again!
The ACA requires insurers to submit an annual report to HHS to account for plan costs. If the insurer does not meet the medical loss ratio standards, this means too large a portion of the premiums charged in the previous year went towards the insurer’s administration, marketing, and profit, instead of going toward paying claims and quality improvement initiatives. In such case, the insurer must provide rebates to policyholders. For 2023, insurers must distribute rebates to employer plan sponsors between August 1, 2023, and September 30, 2023.
Employers should keep in mind that if they receive a rebate, there are strict guidelines as to how the rebate may be used or distributed. Generally, any portion of the rebate that is considered ERISA plan assets (e.g., the portion attributable to participant contributions) must be returned to participants in some form within 90 days of receipt.
For more information, download a copy of our publication, Medical Loss Ratio Rebates: A Guide for Employers.
District of Columbia
Expanding Access to Fertility Treatment Amendment Act Becomes Law
September 26, 2023
After passage by the DC Council in June 2023, approval by Mayor Bowser in July 2023, and the required review by the US Congress, the Expanding Access to Fertility Treatment Amendment Act (DC Law 25-49) became law on September 6, 2023.
Under the new law, health insurance policies are required to provide coverage for infertility diagnosis, infertility treatment, and standard fertility preservation services. The law applies to health insurers issuing group health benefit plans in the District (including small group coverage purchased through the DC Health Link), effective January 1, 2025. Employers sponsoring health plans issued in DC should be aware of this development and contact their carriers for further information.
2024 Individual Mandate Coverage OOP and Deductible Minimum Creditable Coverage (MCC) Limits
September 26, 2023
The Massachusetts Individual Mandate requires each Massachusetts resident to have health coverage that meets the Minimum Creditable Coverage (MCC) standards set by the Commonwealth Health Insurance Connector (Connector) or pay a penalty through their state tax returns. The Connector has announced the 2024 deductibles and out-of-pocket maximum limits for MCC. The 2022, 2023, and 2024 limits are summarized below.
Although employers are not required to provide MCC for their Massachusetts employees, insurers, or in some cases employers, are required to complete Form 1099-HC, which indicates whether a plan provides MCC or not and distribute the form to their Massachusetts employees. The same form must then be submitted to the state Department of Revenue (DOR) by January 31, following the plan year.
Additionally, employers with six or more employees who work in Massachusetts are required to submit an annual report entitled the Health Insurance Responsibility Disclosure (HIRD) form, where MCC status is also reported, by December 15. You can find additional information in the FAQ of the November 10, 2022, edition of Compliance Corner.
Therefore, employers who have employees in Massachusetts should be aware of the 2024 MCC limits.
|Employee-only tier deductible||$2,950||$2,850||$2,750|
|Employee-only tier separate Rx deductible||$360||$350||$340|
|Family tier deductible||$5,900||$5,700||$5,500|
|Family tier Rx deductible||$720||$700||$680|
|Maximum Out-of-Pocket (OOP) Limits||2024||2023||2022|
|Employee-only tier OOP max||$9,450||$9,100||$8,700|
|Family tier OOP max||$18,900||$18,200||$17,400|
Bulletin 03-23. The MCC Regulations for Calendar Year 2024 »
Bulletin 02-22. The MCC Regulations for Calendar Year 2023 »
Bulletin 06-21. The MCC Regulations for Calendar Year 2022 »
Mass Healthcare: Frequently Asked Questions for Employers, Form MA 1099-HC »
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