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PCORI Fees Due to IRS No Later Than August 1, 2022

May 13, 2022/in Aetna, All Savers, Carrier, Compliance, Cornerstone Updates, Employee Benefits, Humana, Legislation, Whitepapers/by Shelly Brownell

Fees to fund the Patient-Centered Outcomes Research Institute (PCORI) are due to the IRS no later than August 1, 2022, from employers who sponsor certain self-insured health plans such as Level Funded and Health Reimbursement Arrangements (HRAs) that are not treated as excepted benefits.

How to Pay PCORI Fees
Employers that sponsor certain self-insured health plans (Level Funded) must report and pay the required PCORI fees via IRS Form 720 along with HRA plans, Quarterly Federal Excise Tax Return. Complete Part II, line 133. Employers should note “2nd Quarter” on the 720 form.

Click here to access the updated 720 form.

The fee applies to each Plan year that ends after October 1, 2012, and before October 1, 2029. “Plan year” refers to the plan year for your Level Funded Medical Plans or an HRA plan. Generally the plan year and the coverage period are the same. As an example, if your HRA benefit resets each January 1, your HRA plan year and your coverage period are generally a calendar year and end December 31.

Plan Year Ending Date Fee
October 1, 2020 – September 30, 2021 $2.66
October 1, 2021 – September 30, 2022 $2.79

There are three available methods that can be used to determine the average number of lives covered under a plan for the policy year. For an HRA plan it is acceptable to use the number of subscribers only. The most commonly used method for determining the fee for your Level Funded plan is the “Snapshot Method”.

  1. Actual Count Method: A plan sponsor may determine the average number of lives covered under a plan for a plan year by adding the totals of lives covered for each day of the play year and dividing that total by the total number of days in the plan year.
  2. Snapshot Method: A plan sponsor may determine the average number of lives covered under an applicable self-insured health plan for a plan year based on the total number of lives covered on one date (or more dates if an equal number of dates is used in each quarter) during the first, second or third month of each quarter, and dividing that total by the number of dates on which a count was made.
  3. Form 5500 Method: An eligible plan sponsor may determine the average number of lives covered under a plan for a plan year based on the number of participants reported on the Form 5500, Annual Return/Report of Employee Benefit Plan, or the Form 5500-SF, Short Form Annual Return/Report of Small Employee Benefit Plan.

Payments should be made payable to the U.S. Treasury and sent by August 1, 2022, to the address below:

Department of the Treasury
Internal Revenue Service
Ogden, UT 84201-0009

The following documents accompany this notice:

  • The Form 720
  • Instructions for the Form 720
  • Patient-Centered Outreach Research Institute Filing Due Dates and Applicable Rates Flier

Tools to Assist you by Carrier:

All Savers®

All Savers posts the employer group’s membership information to the employer website. The employer group is required to complete and file the IRS Form 720. For general questions please contact All Savers Broker Services at 1-866-405-7174.

Humana Level Funded

Humana provides a snapshot report that shows the monthly membership employers will need when filing the PCORI. It is an employer report (instructions below). As a broker, the employer may grant you access if they want you to pull it for them.

Click here to review the instructions.

Aetna Funding Advantage

This link takes you to the Aetna Funding Advantage PCORI Fee Estimator Tool. This tool gives you guidance on calculating the PCORI fees for this group.

 

**Anthem OH SOCA MEWA, Anthem KY Chamber Advantage, Anthem IN Chamber Health Alliance, MMO COSE MEWA, Humana KY Chamber and UHC MEWA have built the PCORI fees into the premiums, therefore, you will not need to file and pay any additional fees.

https://www.crnstone.com/wp-content/uploads/2022/05/PCORI-Fees-Due-to-IRS-No-Later-Than-July-31-2022-1.jpg 480 640 Shelly Brownell /wp-content/uploads/2019/11/Cornerstone_Logo.png Shelly Brownell2022-05-13 14:22:082022-05-31 12:56:49PCORI Fees Due to IRS No Later Than August 1, 2022

UPDATE: Aetna Pricing Changes to Teladoc

September 3, 2021/in Aetna, Carrier, Employee Benefits/by Cornerstone

The Teladoc product pricing balances rising costs of medical costs with market competitive rates for telemedicine vendors.  For 2022, there will be increases to general medical consults only across all lines of business to better align our prices with standard industry rates for telehealth consults.  Otherwise there are no other changes from the 2021 Teladoc pricing model.

  • A general medical consult will be $49
  • No change to behavioral health:
    • An initial psychiatry (MD) visit will be $190; all subsequent psychiatry visits will be $95
    • All therapy (non-MD) visits will be $85.
  • No change in price for dermatology consults, they will remain at $75.
  • Note that in line with the general medical consult, the Caregiving service will be $49 and will continue to be available at no additional charge for all plan sponsors on an opt-in basis.

New Pricing Effective:

Fully Insured & AFA: New pricing will begin January 1, 2022, irrespective of the plan sponsor’s effective date.

Contact your Cornerstone representative with any questions.

https://www.crnstone.com/wp-content/uploads/2021/09/Aetna-Pricing-Changes-to-Teladoc.jpg 480 640 Cornerstone /wp-content/uploads/2019/11/Cornerstone_Logo.png Cornerstone2021-09-03 13:15:422021-09-03 13:19:23UPDATE: Aetna Pricing Changes to Teladoc

Aetna Small Group Administrative Credits and Excellence Broker Program

May 14, 2021/in Aetna, Aetna Funding Advantage, Bonus Programs, Carrier, Employee Benefits/by Cornerstone

Savings Now, Surplus Later

The Aetna Funding Advantage plan offers your small business the claims protection that you need and the opportunity for the surplus payout that you deserve. And now, you can save even more and get a  guaranteed surplus later when you renew.

For each enrolled employee, you can earn a $125 administrative fee credit. This is for groups with 10–100 enrolled employees.

Click here to learn more about the surplus.

2021 Small Group Excellence Broker Program

As an Aetna producer partner, you can earn credits by educating your clients and providing value-added services that help improve the health and productivity of their workforces.

  • Business sold or renewed with effective dates January 1, 2021 through December 31, 2021.
  • Includes cases with 2 to 100 eligible subscribers.
  • Eligible Medical plans and funding arrangementsinclude:
    • Small Group Aetna Funding AdvantageSM planswith 2 to 100 eligible subscribers
    • Fully insured plans with 51 to 100 eligiblesubscribers
  • Program excludes all Affordable Care Act (ACA)business.

Click here to learn more about the bonus program.

Contact your Cornerstone representative with any questions.

https://www.crnstone.com/wp-content/uploads/2021/05/Aetna-Small-Group-Admin-Credits-and-Excellence-Broker-Program.jpg 480 640 Cornerstone /wp-content/uploads/2019/11/Cornerstone_Logo.png Cornerstone2021-05-14 14:40:212021-05-14 14:40:21Aetna Small Group Administrative Credits and Excellence Broker Program

April Updates Regarding Aenta Funding Advantage

April 5, 2021/in Aetna, Aetna Funding Advantage, Carrier, Employee Benefits/by Cornerstone

Small Group AFA Admin Credit and Surplus for 10+

Click here to review the flyer from Aetna.

Dual Option Updates

Aetna is now allowing groups in the two to four enrolled space to set-up a dual option. Previously, they only allowed a single plan design for those groups. Groups of 5 or more enrolled can select up to 4 plan designs with no limitations.

New Business Submission Deadline Reminder for AFA

Effective date submission deadlines for April through June 2021 for customers with AFA are as follows:

Effective date

IMQ Elite Submitted

Underwriting quote submitted

Sales notice submitted

All required documents submitted

April 1 3/15/21 3/20/21 4/2/21 4/8/21
May 1 4/15/21 4/20/21 5/3/21 5/7/21
June 1 5/15/21 5/20/21 6/2/21 6/7/21

Contact your Cornerstone representative for more information.

https://www.crnstone.com/wp-content/uploads/2021/04/April-Updates-Regarding-Aenta-Funding-Advantage.jpg 480 640 Cornerstone /wp-content/uploads/2019/11/Cornerstone_Logo.png Cornerstone2021-04-05 13:43:052021-04-05 14:01:38April Updates Regarding Aenta Funding Advantage

Aetna’s Extension on Cost Share Waivers

February 5, 2021/in Aetna, Aetna Funding Advantage, Carrier, Employee Benefits/by Cornerstone

When COVID-19 escalated in the United States, Aetna implemented a series of cost-sharing waivers to support individuals seeking COVID-19 care. While some of those waivers have expired, they are extending others as noted below.

The charts below indicate those cost-sharing waivers they are extending for Aetna’s insured and Aetna Funding Advantage business:

Contact your Cornerstone representative for more information.

https://www.crnstone.com/wp-content/uploads/2021/02/Aetna-Cost-Sharing-Waivers-Extension.jpg 480 640 Cornerstone /wp-content/uploads/2019/11/Cornerstone_Logo.png Cornerstone2021-02-05 15:11:452021-02-05 15:11:45Aetna’s Extension on Cost Share Waivers

Important Small Group Updates from Aetna Funding Advantage

September 18, 2020/in Aetna, Aetna Funding Advantage, Carrier, Employee Benefits/by Cornerstone

New Plan Sponsor Campaign to Drive Aetna Funding Advantage (AFA) Benefits Engagement

Throught Aetna’s new plan sponsor engagement email campaign, your clients can easily educate their employees and share information with them about their AFA health benefits. The goal of the campaign is to drive engagement, raise awareness, increase product adoption and use, and strengthen the Aetna brand.

The campaign was launched at the beginning of September and will run through December. Three emails will be sent each month—near the beginning, middle, and end of the month. The topics include:

  • Week 1 each month – Aetna HealthSM website/app sign-up
  • Week 2.5 each month – Aetna value-add program engagement: Peerfit and EAP
  • Week 3.5 each month – Attain by Aetna® app sign-up/usage

Click here to view a sample plan sponsor email.

Simplifying 2020 Open Enrollment with New Fulfillment Vendor

The new commercial open enrollment portal is now live for ordering materials and kits through O’Neil Digital Solutions, Aetna’s new fulfillment supplier. The ONEkit portal is their exclusive resource to create dynamic open enrollment materials, which can be downloaded immediately and are free of charge. It also encourages using digital first, improves efficiencies, and supports the needs for customization. Aetna has integrated AetnaTrak and Communications Hub capabilities into this one-stop vendor solution—making it easier for you to help support your small group AFA clients’ open enrollments.

You can order enrollment kits and materials quickly and easily through Producer World. Prompts on the page will direct you, depending on whether you’re ordering materials for the first time or you’ve ordered in the past.

1095-B Tax Forms Update

One of the big perks of AFA plans is that Aetna helps with the preparation, filing, and delivery of 1095-B tax forms for members.

For this tax year, they will soon be processing the 1095-B forms for AFA groups with 5 to 50 employees, who have not opted out. Be on the lookout for more information coming soon.

Reminder: New Business AFA Submission Deadlines Through 2020 and Beginning of 2021

With Q4 2020 and Q1 2021 quickly approaching, please be sure to refer to the chart below for upcoming AFA effective dates’ submission deadlines:

Effective date

IMQ Elite
submitted

Underwriting
quote submitted

Sales notice
submitted

All required
documents
submitted

October 1 9/15/20 9/20/20 10/2/20 10/8/20
November 1 10/15/20 10/20/20 11/3/20 11/9/20
December 1 11/15/20 11/20/20 12/3/20 12/9/20
January 1 12/15/20 12/20/20 1/4/21 1/8/21
https://www.crnstone.com/wp-content/uploads/2020/09/Important-Small-Group-Updates-from-AFA.jpg 480 640 Cornerstone /wp-content/uploads/2019/11/Cornerstone_Logo.png Cornerstone2020-09-18 19:10:482020-09-18 19:10:49Important Small Group Updates from Aetna Funding Advantage

RSVP Today! 2021 Small Group Carrier Update Webinars

September 1, 2020/in Aetna, Anthem, Carrier, Cornerstone Updates, Employee Benefits, Humana, Medical Mutual, UnitedHealthcare/by Cornerstone

Join us for these brief, informative sessions focused on small group to get up-to-speed on 2021 plans, what to expect with renewals, and more!

Unable to make a session? No problem! We are recording sessions for our agents who aren’t able to attend. Please contact your Cornerstone representative for a link to the recording and materials.

*Sessions are for active Cornerstone Employee Benefit agents.

Webinar Schedule:

Day 1: Monday September 14, 2020

9:00 am–10:00 am — Aetna, hosted by Nelson Culp

  • Scott Bredmour from Aetna will cover their 2 to 100 eligible level-funded product (Aetna Funding Advantage). With Aetna now a CVS company, Scott will go through how all members can get a COVID-19 test through one of their CVS locations without a doctors note and no cost to the member, as well as how you can book an appointment online.

10:00 am–11:00 am — Humana, hosted by Shelly Brownell

  • Humana’s Leslie Isler will cover dental and vision, a level-funded premium overview, On Hand, a reminder about EAP, and Go365 updates.

Register for the September 14 webinars

Day 2: Monday September 21, 2020

9:00 am–10:00 am — Anthem and Anthem SOCA, hosted by Shelly Brownell

  • Please join the Anthem sales team as they cover new products and networks for 2021, technology enhancements for members, and more for small group 2 to 50 and key accounts 51 to 99.

Register for the September 21 webinar

Day 3: Monday September 28, 2020

9:00 am–10:00 am — MMO and MMO COSE, hosted by Kim Kinnaird

  • MMO will present updates on all their plans for January 2021 including ACA, Grandmothered/Grandfathered, the COSE MEWA, and ancillary. They’ll also cover what to expect with upcoming renewals and new options for wellness.

10:00 am–11:00 am — UnitedHealthcare, hosted by Jeff Lewis

  • Get up to speed for fourth quarter with UnitedHealthcare. UHC will discuss January 1, 2021, readiness for small businesses (2–50).

Register for the September 28 webinars

https://www.crnstone.com/wp-content/uploads/2020/09/2021-Small-Group-Webinars.jpg 480 640 Cornerstone /wp-content/uploads/2019/11/Cornerstone_Logo.png Cornerstone2020-09-01 14:09:562020-09-01 16:50:52RSVP Today! 2021 Small Group Carrier Update Webinars

GREAT NEWS: Aetna and Cleveland Clinic to Offer New Plans for Employers

August 19, 2020/in Aetna, Carrier, Employee Benefits/by Cornerstone

Aetna has partnered with Cleveland Clinic to form an Accountable Care Organization (ACO) model and offer new plans and programs featuring Cleveland Clinic providers.

Cleveland Clinic and Aetna participating employers could save as much as 10 percent in health care spending by choosing the new plan over a current Aetna broad network plan. Quotes released on or around September 1, 2020, with a October 1, 2020 effective date or later will have the new ACO plans and rates.

The collaboration includes the launch of a co-branded insurance plan, which could reduce health care costs for participating employers, an expanded relationship nationwide to provide members enrolled in Aetna commercial plans access to second opinions by Cleveland Clinic for certain conditions, and the deployment of Cleveland Clinic’s Cardiac Center of Excellence (COE) program to Aetna plan sponsors.

The Aetna Whole Healthsm – Cleveland Clinic co-branded commercial plan offers Northeast Ohio employers and their plan members positive clinical outcomes, improved experience and reduced total cost of care. Care is delivered in a coordinated approach through Cleveland Clinic’s network of employed, aligned and affiliated providers. Under the new plan, Aetna members can receive care from the Cleveland Clinic Quality Alliance network of employed and independent community physicians or at any Cleveland Clinic facility. Cleveland Clinic will be rewarded for achieving quality and cost targets.

The Aetna Whole Healthsm – Cleveland Clinic plan provides employers a cost-effective offering beyond Aetna’s typical broad network plans, while also giving members access to Cleveland Clinic’s care providers. Cleveland Clinic and Aetna participating employers could save as much as 10 percent in health care spending by choosing the new plan over a current Aetna broad network plan.

The organizations have also worked together to expand these savings nationwide, offering Aetna commercial members a new program with streamlined scheduling for specialty services and access to health-plan directed, virtual second opinion services at Cleveland Clinic through a dedicated specialty referral line for Aetna members. Aetna care managers will work one-on-one with members to navigate their specific health needs and personalized care plans.

Fully insured and self-insured employers in Ashtabula, Cuyahoga, Geauga, Lake, Lorain, Medina, Portage, Stark, Summit, and Tuscarawas counties can begin purchasing Aetna Whole Healthsm – Cleveland Clinic plans beginning in the fall of 2020, depending on segment and group size.

This new multi-faceted relationship will involve additional programs and expanded services. For example, the organizations are also launching a Cardiac COE program to offer Aetna plan sponsors across the country cardiac care at Cleveland Clinic, which is home to the No. 1-rated heart program in the nation for the past 26 consecutive years as ranked by U.S. News & World Report. The Cardiac COE program is designed to offer patients improved clinical outcomes as well as faster return to work and other activities of their daily lives.

Both organizations are committed to continue working on new initiatives to bring innovative, transformative, and cost-effective care to local communities.

Click here to read the full press release from Aetna and Cleveland Clinic.

Contact your Cornerstone representative with any questions.

https://www.crnstone.com/wp-content/uploads/2020/08/Aetna-and-CVS-Partnership.jpg 480 640 Cornerstone /wp-content/uploads/2019/11/Cornerstone_Logo.png Cornerstone2020-08-19 20:10:272020-08-20 14:18:10GREAT NEWS: Aetna and Cleveland Clinic to Offer New Plans for Employers

Why Aetna International?

July 29, 2020/in Aetna, Carrier, Employee Benefits/by Cornerstone

Expatriates, inpatriates, local nationals, and business travelers need the peace-of-mind and confidence that comes from a strong and experienced global leader offering a comprehensive health care benefits strategy. If you have a group customer that has some sort of International exposure, Aetna International has the tools, resources, and plan offerings needed to ensure your valued customer is properly taken care of.

We are very grateful to Andy Koesterman, Aetna’s sales representative for this product, who was kind enough to provide a 1 hour CE for Cornerstone agents on international benefits.

Click here to view the PDF or contact your Cornerstone representative for more information.

https://www.crnstone.com/wp-content/uploads/2020/07/Why-Aetna-International.jpg 480 640 Cornerstone /wp-content/uploads/2019/11/Cornerstone_Logo.png Cornerstone2020-07-29 20:36:582020-07-29 20:36:59Why Aetna International?

WEBINAR WITH CE AVAILABLE: Get the Latest Updates on Aetna’s New Plans for Groups

July 1, 2020/in Aetna, Carrier, Employee Benefits/by Cornerstone

Cornerstone is hosting a two-hour web-based training and CE session. Get the latest updates on Aetna’s new plans available September 1 along with 1 hour Ohio CE on Wednesday, July 15 from 10:00 am to 12:00 pm.

The Aetna team will review updates to their employer plan portfolio available September 1, go over their current plans and  value adds.

The CE is “Understanding an Employer’s Risk to Global Assignments,” a one hour CE course covering several topics for groups with International exposure, such as risk diversity by population, compliance, health and well-being, employee safety, global security, and mitigating strategies. Presented by Andy Koesterman.

YOU MUST REGISTER AND COMPLETE A FORM BY JULY 10, 2020:

1. Click here when the webinar starts.

(The session password is Cornerstone2020! If you don’t have WebEx loaded on your computer, there is an option to join by web browser.)

2. To receive CE credit for this course, please fill out this attestation and licensing information document and return it to koestermana@aetna.com by Friday, July 10, 2020.

Contact your Cornerstone representative with any questions.

https://www.crnstone.com/wp-content/uploads/2020/06/CE-Available-Aetna-New-Plans.jpg 480 640 Cornerstone /wp-content/uploads/2019/11/Cornerstone_Logo.png Cornerstone2020-07-01 19:08:562020-07-15 13:05:54WEBINAR WITH CE AVAILABLE: Get the Latest Updates on Aetna’s New Plans for Groups
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