CMS Medicare Part D Disclosure Due by March 1, 2024
All fully insured and self-insured plans (including level-funded plans) of all sizes, including church and governmental plans, must annually disclose to CMS whether their plan’s prescription drug coverage is creditable. Generally, “creditable coverage” refers to prescription drug coverage that is expected to pay (based on the actuarial value) on average at least as much as Medicare Part D coverage.
The disclosure must be made to CMS within 60 days of the start of the policy or contract year. Accordingly, for calendar year prescription drug policies, the Medicare Part D disclosure is due to CMS by March 1, 2024.
For additional information about the disclosure to CMS, please download a copy of Medicare Part D Disclosures: A Guide for Employers. The publication includes links to the CMS website and instructions for accessing the disclosure form.
Upcoming ACA Form 1094/5 Reporting Deadlines
Applicable large employers (ALEs) with 50 or more full-time employees (FTEs), including full-time equivalent employees, in the prior year who sponsored group health plans (whether insured or self-insured) must comply with IRC Section 6056 reporting in early 2024. Specifically, ALEs must complete and distribute Form 1095-C to full-time employees by March 1, 2024. The form should include details regarding whether the employee was offered minimum value, affordable coverage during 2023. The forms may be mailed, electronically delivered, or delivered by hand (although proof of delivery in some manner is recommended).
Employers who sponsored a self-insured plan during 2023 must comply with Section 6055 reporting in 2024. Self-insured ALEs must complete Section III of Form 1095-C detailing which months the employee (and any applicable spouse and dependents) had coverage under the employer's plan. If the self-insured employer has fewer than 50 FTEs, it must complete and distribute a Form 1095-B with such information. Again, the forms must be delivered to employees by March 1, 2024.
If the self-insured employer has fewer than 50 FTEs, an alternative is available to distributing Form 1095-B to individuals. These small employers are permitted to post a clear and conspicuous notice on their website of the document's availability and the necessary contact information to request it. Any such request must be fulfilled within 30 days. This alternative is not available for Form 1095-C.
Employers must also file the forms with the IRS by February 28, 2024, if filing by paper, and April 1, 2024, if filing electronically. The filing must include the transmittal Form 1094-C (if filing Forms 1095-C) or Form 1094-B (if filing Forms 1095-B). Importantly, beginning this year, employers that file 10 or more returns of any type (i.e., counting Forms 1094/1095, W-2, and 1099 together) to the IRS in a calendar year must do so electronically absent a hardship waiver.
Additionally, employers with employees located in states with an individual mandate may also have to comply with state reporting requirements and should be aware of the applicable deadlines.
For more information on ACA and/or state reporting requirements, please download a copy of our ACA: Employer Mandate Reporting Requirements and State Individual Mandate Reporting Requirements publications.
An employee is asking for copies of several documents relating to the medical plan. Do I have to give them to him?
DE Mandatory Coverage of Annual Behavioral Health Well Check
On January 25, 2024, the Delaware Department of Insurance issued a bulletin (No. 134) to remind all insurers in Delaware that beginning on January 1, 2024, insurers are required to cover annual behavioral health well checks.
A “behavioral health well check” is defined in the law as a pre-deductible annual visit with a licensed mental health clinician with, at minimum, a master’s level degree. The behavioral health well check visit must include but is not limited to a review of medical history, evaluation of adverse childhood experiences, use of a group of developmentally appropriate mental health screening tools, and may include anticipatory behavioral health guidance congruent with the patient’s stage of life using the diagnosis of “annual behavioral health well check.”
The annual behavioral health well check generally must be reimbursed at the same rate that such common procedural terminology codes are imbursed for the provision of other medical care.
IL Updates 2024 Health Benefits Disclosure Template
The Illinois DOL (IDOL) recently published the updated Illinois Consumer Coverage Disclosure Act (CCDA) template for 2024. The list of Essential Health Benefits (EHB) did not change from 2023 to 2024, but employers should begin using the 2024 template.
As a reminder, the CCDA requires employers to provide eligible employees with a disclosure that compares their coverage to essential health benefits required for coverage received through the Illinois marketplace. The disclosure must be provided upon hire, annually thereafter, and at the request of an employee.
The CCDA applies to all employers with employees in Illinois who provide group health insurance coverage. Importantly, this requirement applies to both fully insured and self-insured plans.
Employers who offer group health plans in Illinois should be aware of this ongoing requirement, review the updated 2024 template, and have discussions with carriers and TPAs, as applicable, to ensure compliance.
This material was created by PPI Benefit Solutions to provide accurate and reliable information on the subjects covered but should not be regarded as a complete analysis of these subjects. It is not intended to provide specific legal, tax or other professional advice. The service of an appropriate professional should be sought regarding your individual situation. PPI does not offer tax or legal advice. "PPI®" is a service mark of Professional Pensions, Inc., a subsidiary of NFP Corp. (NFP). All rights reserved.