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

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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:

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.

What Happens to Unused Amounts in Employees’ HRAs When Their Employment Terminates?

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This post was originally published by EBIA.

QUESTION: Our company is thinking about adding an HRA that would be integrated with our major medical plan. Employees could carry over their HRA balances from year to year. What happens to those balances when an employee’s employment terminates?

ANSWER: Your company has some choices about what will happen to HRA balances remaining at termination of employment. The HRA may be designed so that employees forfeit their unused HRA balances when employment ends (typically after a limited post-termination opportunity to submit reimbursements for pre-termination expenses). Or your company may choose a design that permits employees to “spend down” their HRA balances and receive reimbursement for eligible expenses incurred after employment termination until the HRA balance is depleted. Alternatively, the HRA could be designed so that all but a nondiscriminatory class of employees forfeit unused amounts at termination. Regardless of which design you choose, terminated employees may not be “cashed out” of their HRAs (i.e., provided with cash or other benefits in an amount equal to some or all of the HRA balance), because a cash-out feature would trigger taxation of all HRA distributions, whether or not they were used to pay qualified medical expenses. The design choices you make should be clearly stated in the HRA plan document and explained to employees in the summary plan description and other communication materials.

Whether or not the balance is forfeited, COBRA must be offered unless an exception applies (e.g., because the HRA is sponsored by a small employer that is exempt from COBRA). If COBRA coverage is purchased, the recipient will have access to the HRA balance (notwithstanding any forfeiture rule), increased by any account credits that would be received for the coverage period by a similarly situated non-COBRA beneficiary. Note that COBRA’s application to HRAs raises some complex issues that are beyond the scope of this answer.

If an employee dies while eligible to incur reimbursable expenses, the HRA may allow the employee’s accumulated balance to reimburse the substantiated qualified medical expenses of the employee’s surviving spouse, children who are under age 27 as of the end of the taxable year, or tax dependents for health coverage purposes. A deceased employee’s balance may not be used to reimburse the medical expenses of anyone other than those individuals (there is a limited exception for certain state governmental HRAs), or paid for any reason other than medical expense reimbursement. For more information, see EBIA’s Consumer-Driven Health Care manual at Sections XXI.F.12 (“Forfeit Account Balances or Permit Spend-Downs?”), XXII.C.2 (“Treatment of HRAs Upon a Participant’s Death”), XXIV.F (“No Cash-Out of Unused Amounts”), and XXV.B (“HRAs and COBRA”). See also EBIA’s COBRA manual at Sections IV.C (“Small Employer Exception”) and XI.G (“How COBRA Applies to HRAs: Unique COBRA Administration Issues”).

IRS Releases HSA Limits for 2023

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IRS recently issued Revenue Procedure 2022-24, which provides the 2023 cost-of-living contribution and coverage adjustments for HSAs, as required under Code Section 223(g). It also includes the 2023 limit for Excepted Benefit HRAs. The limits for many items have increased for 2023.

2022

2023
Annual HSA Contribution Amounts

Individual

Family

Catch-up

  

$3,650

$7,300

$1,000

  

$3,850

$7,750

$1,000
Annual Maximum Out-of-Pocket Limits for HDHP

Individual

Family

  

$7,050

$14,100

  

$7,500

$15,000
Annual Minimum Deductible Amount Limits for HDHP

Individual

Family

  

$1,400

$2,800

  

$1,500

$3,000
Excepted Benefit HRA

$1,800

$1,950

 

For a copy of Revenue Procedure 2022-24, click here.

 

If you have any comments or questions regarding any of the above information, please do not hesitate to call me at (708) 717-9638 or email me at larry@larrygrudzien.com

Urgent: Submit Documents Before Data Matching Issue Deadlines!

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Agents and brokers play a vital role in helping consumers understand data matching issues (DMIs) and submit documents or update their application to resolve their issues. DMIs are caused when information on a consumer’s application does not match the Centers for Medicare & Medicaid Services (CMS) trusted data sources or CMS does not have available data for a consumer.

Now is a critical time in the DMI process for consumers with open issues on their Plan Year 2022 applications because:

  • Large numbers of consumers are running out of time to submit documents to resolve their data matching issues.
  • Consumers who do not resolve their issues will lose advance payments of the premium tax credit (APTC) or coverage.
  • Agents/Brokers will lose commissions for many of these consumers if documents are not submitted and issues are not resolved.
  • Check consumer accounts NOW and have consumers submit any needed documents

Common Causes of DMI Expirations (when a DMI is not resolved):

  • The consumer did not submit any supporting documentation.
  • The type of documentation submitted is not on the list of approved documents for the consumer’s specific DMI. Frequent issues include:
  • Income documentation that is more than two years old.
  • Submitting a Social Security number (SSN) card to resolve a citizenship DMI. You should submit a passport or other acceptable document from the list, since an SSN card will not resolve a citizenship issue on its own.
  • The documentation submitted does not have enough information to resolve the data inconsistency, such as only submitting income information for the applicant’s job but no information for their spouse’s job.
  • The documentation submitted has errors, such as the name on the application is different than on the submitted document.
  • The documents submitted are not in the proper format (they must be .pdf, .jpeg, .jpg, .gif, .xml, .png, .tiff, or .bmp, and no larger than 10 megabytes).
  • The information provided on the consumer’s application was incorrect.

To learn more about helping consumers resolve DMIs, please view the webinar deck “Helping Consumers Resolve DMIs” available on REGTAP. Additionally, check out the resources below.

Agent/Broker-Specific:

General Audience:

Contact your Cornerstone representative with any questions.

Supreme Court Blocks Vaccine Mandate for Large Businesses, Allows it for Health Care Workers

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Please note:  The Supreme Court has ruled this as a stay for how this was written. If OSHA or the Biden Administration were to re-write this mandate in a more acceptable form, then it could go into effect in the future.

The U.S. Supreme Court issued two highly anticipated rulings on Thursday, temporarily blocking a Biden administration COVID-19 vaccine mandate for large employers but allowing a separate rule applying only to health care workers at facilities receiving federal funding.

The high court settled the matter concerning large employers in a 6-3 decision to block the rule that would have been issued by the Occupational Safety and Health Administration, with the three liberal justices dissenting.

“OSHA has never before imposed such a mandate. Nor has Congress. Indeed, although Congress has enacted significant legislation addressing the COVID–19 pandemic, it has declined to enact any measure similar to what OSHA has promulgated here,” the majority opinion stated.

As for health care facilities, the court ruled 5-4 to uphold for now the rule administered by the Department of Health and Human Services, with Justices Clarence Thomas, Samuel Alito, and Neil Gorsuch dissenting.

“Both Medicare and Medicaid are administered by the Secretary of Health and Human Services, who has general statutory authority to promulgate regulations ‘as may be necessary to the efficient administration of the functions with which [he] is charged.’ One such function — perhaps the most basic, given the Department’s core mission — is to ensure that the health care providers who care for Medicare and Medicaid patients protect their patients’ health and safety,” the majority stated.

The rulings take effect immediately and will remain in place until legal challenges over their constitutionality are resolved through the justice system, and possibly through the Supreme Court.

A mandate targeting half the U.S. workforce

The administration’s employer mandate, announced by senior officials in early November, with an original effective date of Jan. 4, targets about 84 million U.S. workers, or roughly half of the U.S. workforce. Its deadline for employers to require masking was extended to Jan. 10. Full compliance, which the court’s decision now renders renders unenforceable, had been extended to Feb. 9.

Contact your Cornerstone representative with any questions.

Insurance Companies and Group Health Plans Now Required to Cover Costs of At-Home COVID-19 Tests

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The following information was originally posted by CMS.gov.

As part of its ongoing efforts across many channels to expand Americans’ access to free testing, the Biden-Harris Administration is requiring insurance companies and group health plans to cover the cost of over-the-counter, at-home COVID-19 tests, so people with private health coverage can get them for free starting January 15th. The new coverage requirement means that most consumers with private health coverage can go online or to a pharmacy or store, buy a test, and either get it paid for up front by their health plan, or get reimbursed for the cost by submitting a claim to their plan. This requirement incentivizes insurers to cover these costs up front and ensures individuals do not need an order from their health care provider to access these tests for free.

Beginning January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID-19 diagnostic test authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to have those test costs covered by their plan or insurance. Insurance companies and health plans are required to cover 8 free over-the-counter at-home tests per covered individual per month. That means a family of four, all on the same plan, would be able to get up to 32 of these tests covered by their health plan per month. There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment, including for those who may need them due to underlying medical conditions.

“Under President Biden’s leadership, we are requiring insurers and group health plans to make tests free for millions of Americans. This is all part of our overall strategy to ramp-up access to easy-to-use, at-home tests at no cost,” said HHS Secretary Xavier Becerra. “Since we took office, we have more than tripled the number of sites where people can get COVID-19 tests for free, and we’re also purchasing half a billion at-home, rapid tests to send for free to Americans who need them. By requiring private health plans to cover people’s at-home tests, we are further expanding Americans’ ability to get tests for free when they need them.”

Over-the-counter test purchases will be covered in the commercial market without the need for a health care provider’s order or individualized clinical assessment, and without any cost-sharing requirements such as deductibles, co-payments or coinsurance, prior authorization, or other medical management requirements.

As part of the requirement, the Administration is incentivizing insurers and group health plans to set up programs that allow people to get the over-the-counter tests directly through preferred pharmacies, retailers or other entities with no out-of-pocket costs. Insurers and plans would cover the costs upfront, eliminating the need for consumers to submit a claim for reimbursement. When plans and insurers make tests available for upfront coverage through preferred pharmacies or retailers, they are still required to reimburse tests purchased by consumers outside of that network, at a rate of up to $12 per individual test (or the cost of the test, if less than $12). For example, if an individual has a plan that offers direct coverage through their preferred pharmacy but that individual instead purchases tests through an online retailer, the plan is still required to reimburse them up to $12 per individual test. Consumers can find out more information from their plan about how their plan or insurer will cover over-the-counter tests.

“Testing is critically important to help reduce the spread of COVID-19, as well as to quickly diagnose COVID-19 so that it can be effectively treated. Today’s action further removes financial barriers and expands access to COVID-19 tests for millions of people,” said CMS Administrator Chiquita Brooks-LaSure.

State Medicaid and Children’s Health Insurance Program (CHIP) programs are currently required to cover FDA-authorized at-home COVID-19 tests without cost-sharing. In 2021, the Biden-Harris Administration issued guidance explaining that State Medicaid and Children’s Health Insurance Program (CHIP) programs must cover all types of FDA-authorized COVID-19 tests without cost sharing under CMS’s interpretation of the American Rescue Plan Act of 2019 (ARP). Medicare pays for COVID-19 diagnostic tests performed by a laboratory, such as PCR and antigen tests, with no beneficiary cost sharing when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional. People enrolled in a Medicare Advantage plan should check with their plan to see if their plan offers coverage and payment for at-home over-the-counter COVID-19 tests.

This effort is in addition to a number of actions the Biden Administration is taking to expand access to testing for all Americans. The U.S. Department of Health and Human Services (HHS) is providing up to 50 million free, at-home tests to community health centers and Medicare-certified health clinics for distribution at no cost to patients and community members. The program is intended to ensure COVID-19 tests are made available to populations and settings in need of testing. HHS also has established more than 10,000 free community-based pharmacy testing sites around the country. To respond to the Omicron surge, HHS and FEMA are creating surge testing sites in states across the nation.

Contact your Cornerstone representative with any questions.

Good Faith Compliance Standard Announced for Broker Compensation Disclosure Requirements

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This post was originally published by NAHU.

Since the passage of the CAA, NAHU has been advocating for guidance from the DOL regarding the broker compensation transparency requirements included in the bill. Late last week, the DOL released a bulletin including a temporary enforcement policy, an emphasis on good faith compliance and several other items NAHU specifically requested clarification on.

The DOL recognized NAHU’s concerns that compensation, especially indirect compensation, for agents, brokers and consultants can be earned in many forms and as a result there are a variety of ways in which this can be disclosed while still being in compliance with the law.

The DOL also clarified that the implementation date of December 27, 2021, reflects the date by which a contract was entered into regardless of whether the plan year begins after that date. NAHU specifically asked for clarification on this to confirm that any agreements signed prior to December 27, 2021 would not fall under the requirements for disclosure even if the plan year begins on January 1, 2022.

Other items in the bulletin include guidance on excepted benefits and the definitions of “covered plan” and “covered service providers.” The bulletin also states that the DOL is not expecting to release any formal rulemaking or further guidance beyond what is included in the bulletin.

The full bulletin can be found here along with a press release from the DOL. NAHU’s Compliance Now Blog also features a special news bulletin on this guidance and we will be providing more information about this guidance in Friday’s Washington Update and on NAHU’s Healthcare Happy Hour podcast.

NAHU’s full library of broker compensation disclosure resources is available here.

Contact your Cornerstone representative with any questions.

IRS Releases Updated Benefit Limits for 2022

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The IRS recently released additional information regarding 2022 benefit limits. As always, Cornerstone has provided a comprehensive guide to each year’s limits. Click below to access the latest guide.

Access the updated 2022 Benefit Limits Guide

Contact your Cornerstone representative with any questions.

IRS Extends ACA Reporting Deadline for Furnishing Statements for 2021 for 30 days

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This post was originally published by Larry Grudzien, Attorney at Law.

In proposed regulations released on November 22, 2021, the IRS permanently and automatically extends the deadline for 30 days from January 31, 2022 each year for employers and insurers to furnish individual statements on health coverage and full-time employee status (Forms 1095-B and 1095-C). This new requirement applies to the 2021 reporting (March 2, 2022).

The proposed regulations do not extend the good-faith penalty relief to 2021 for incorrect or incomplete reports due in 2022.

In the proposed regulations, the IRS did not extend the due date for filing the 1094 and 1095 forms with the IRS, February 28, 2022 (if filing by paper) or March 31, 2022 (if filing electronically).

Please remember that filers can still take advantage of an automatic 30-day extension of the IRS filing deadline by submitting Form 8809 before the relevant due date.

IRS indicated that it will not assess a penalty for providing Form 1095-B if the reporting entity posts a notice prominently on its website stating that responsible individuals may receive a copy of their 2021 Form 1095-B upon request, accompanied by an email address and a physical address to which a request may be sent, as well as a telephone number that responsible individuals can use to contact the reporting entity with any questions. The reporting entity must furnish a 2021 Form 1095-B to any responsible individual upon request within 30 days of the date the request is received.

In addition, this alternative manner will apply to taxable years when the employer shared responsibility payment amount is zero.

When the notice is posted on the employer’s website , it must written in plain, non-technical terms and must remain on the website until October 15 of the year following the the calendar year in which the Form relates.

In regard to Applicable Large Employer (ALE) members who sponsor self-insured health plans, the above furnishing relief does not apply to furnishing full-time employees with copies of Form 1095-C. Penalties will continue to be assessed consistent with prior enforcement policies for any failure by ALE members to furnish Form 1095-C, including Part III, according to the applicable instructions.

However, the above furnishing relief does extend to penalty assessments in connection with the requirement to furnish Form 1095-C to any employee enrolled in an ALE member’s self-insured health plan who is not a full-time employee for any month of 2021.

For a copy of regulations, please click on the link below:

Information Reporting of Health Insurance Coverage and Other Issues under §§ 5000A, (irs.gov)

Direct and Indirect Compensation Transparency Requirements for Your Group Health Plans

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In response to the Consolidated Appropriations Act of 2021 (CAA) enacted by Congress in December 2020, brokers are now required to disclose compensation amounts if they reasonably expect to receive $1,000 or more in compensation, whether direct or indirect, for their services. This includes all revenue related to brokerage services and/or consulting services for all medical, dental, and vision group health plans of all sizes. These regulations are subject to change in the future upon release of further regulations, but this is the information we have thus far.

This law applies to contracts that are executed or renewed on or after December 27, 2021. This means, if you close your renewals by December 27, you will not have to disclose compensation for 2021. You would, instead, start disclosing compensation with February 1, 2022, groups.

This law also applies to individual market coverage (including student health insurance), however, the interim regulations have put the disclosure responsibility on the carriers.

The description of the compensation can be expressed in multiple ways in the fee disclosure. This means, because most commission scales from the carrier are on a per employee per month (PEPM) basis, you can disclose the PEPM, percentage of premium compensation, or you can choose to disclose the total annual compensation.

As a result of this law, brokers must provide a contract or consulting agreement that includes the following information:

  • A description of the services to be provided by the agent, including:
    • Enrollment
    • Renewal
    • Human Resources
    • Account management
    • Compliance
    • Consulting
  • A description of all direct and indirect compensation

So, What Now?

Cornerstone has provided disclosure and engagement letter templates for your benefit to ensure the communications with your clients are as seamless as possible.

Here are your next steps:

  1. Comprise a list of all your active groups for medical, dental, and vision sales, regardless of size.
  2. Gather your most recent commission statements. Medical and ancillary commissions for Anthem KY, Anthem IN and Humana can be found on the AGB broker commission portal. Statements for medical and ancillary lines from all other Cornerstone carrier partners have been provided to you directly by the carriers, including Aetna, Anthem OH, Humana, Medical Mutual of Ohio, and UnitedHealthcare.
  3. Select one of the two available disclosures and use the template letter to disclose compensation amounts for each
    1. Template broker compensation letter
    2. Disclosure option 1 (provided by NAHU and Cornerstone)
    3. Disclosure option 2
  4. Email the disclosure to each of your groups’ primary contacts.
  5. Repeat annually with each client or as compensations changes due to carrier moves throughout the year.

Please note on the disclosures that it is suggested that you obtain your client’s signature acknowledging receipt of this information. For January 1, 2022, renewals completed before December 27, it is recommended that you follow up with an email from your client to acknowledge the renewal is finalized. Contact your Cornerstone broker advisor with any questions you might have about this new law and the requirements.

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