PCORI Fees Due to IRS No Later Than July 31

Fees to fund the Patient-Centered Outcomes Research Institute (PCORI) are due to the IRS no later than July 31, 2019 from employers who sponsor certain self-insured health plans, which includes all level funded as well as 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.

The fee applies to each Plan year that ends after October 1, 2012, and before October 1, 2019. “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, 2017 – September 30, 2018 $2.39
October 1, 2018 – September 30, 2019 $2.45

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 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 July 31, 2019 to the applicable address on the attached instructions.

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

Click here.

Aetna Funding Advantage

This link takes you to your Producer World login and will assist in determining the fee due by your group.

LIVE TRAINING: Aetna’s AFA Springboard System

Cornerstone invites you to attend training on Aetna’s AFA Springboard System at the Cincinnati office!

Please join us for an overview of the Aetna Springboard process for new business submissions, presented by Aetna’s Jordan Finley and Lauren Horley.

DATE: Monday June 24, 2019

TIME: 2:00–3:30 pm

LOCATION: Cornerstone’s Cincinnati Office

2101 Florence Ave Cincinnati, OH 45206

Click here to RSVP.

Medical Mutual Has Extended The Mid-Size Group Volume Bonus Program

Medical Mutual has extended their Mid-Size Group (51–99) Volume Bonus Program for the period from July 1 to December 31, 2019. This program pays a per-employee per-month bonus on 51–99 group contracts with effective dates through December 31, 2019, as follows:

Tier Mid-size Group Book of Business Bonus Amount
1 75-199 contracts $4 per employee per month
2 200-349 contracts $7 per employee per month
3 350-499 contracts $10 per employee per month
4 500+ contracts $13.50 per employee per month

As a reminder, the Small Group (1–50) Volume Bonus Program is in effect through Dec. 31, 2019.

Click here for more information about the Mid-Size Group Bonus Program.

If you have any questions, please contact your Cornerstone representative.

UPDATE: New IMQ From Aetna Funding Advantage

Aetna Funding Advantage has restructured their Individual Medical Questionnaire (IMQ) to make the process easier. The new IMQ can  now be accessed on Producer World.

Aetna clarified conditions and created high-level buckets of conditions to make it easier for members to review and answer questions on their health history.

You can start using the new small group AFA IMQ today. Starting September 1, 2019, Aetna will no longer accept the old IMQ.

Click here to access the Aetna AFA Medical and Stop Loss Employee Enrollment/Change Form

New From Aetna: AFA IMQ and IMQ Support

Aetna Funding Advantage’s (AFA) Individual Medical Questionnaires (IMQs) could potentially lower monthly costs and bring more stable renewals and higher surplus payouts. Aetna’s IMQ Elite concierge team will send out, collect and submit digital IMQs on your behalf.

Click here for more information.

Contact your Cornerstone representative for more information.

DON’T FORGET: Case Submission Deadlines for Small Group Aetna Funding Advantage

June 1 effective date deadlines for Aenta Funding Advantage small group (5–50*) case submissions are fast approaching. Review all new business submission deadlines for June through October below…

Effective date
Sales notice submitted
All required documents submitted
June 1
5/28/2019
5/31/2019
July 1
6/26/2019
7/1/2019
August 1
7/29/2019
8/1/2019
September 1
8/27/2019
8/30/2019
October 1
9/26/2019
10/1/2019

*2 to 50 in GA/PA/TX, 2 to 100 in N. IL, 5 to 100 in CO/CT/KY/LA/MA/NJ/OH, 10 to 50 in NV and 26 to 50 in NC.

Contact your Cornerstone representative with any questions.

Anthem SOCA BP New Sold Case Requirements

Effective May 15, Anthem SOCA BP will require the Annual Rate and Census Reconciliation (ARC) form for new sold submissions to ensure that plans comply with reporting requirements. The Quarterly Wage and Tax Statement will no longer be required.

The revised Sold Case Checklist will include the following documents:

  • Participation Agreement
  • Benefit Rate Proposal
  • Association Membership/Proof
  • Electronic Funds Transfer (EFT) Banking Form
  • Voided Check
  • Business Acknowledgement Agreement
  • Annual Rate & Census Reconciliation Form

Click here to view the 2019 Anthem SOCA Benefit Plan Sold Case Checklist.

Contact your Cornerstone representative with any questions.

SAVE THE DATE: Cornerstone’s CE Program in NW Ohio

Cornerstone in NW Ohio is hosting a CE program for Cornerstone group agents on Wednesday, June 19, 2019, with 2 credit hours available at a location in Toledo:

 

PLACE

Swan Creek Metro Park

Yager Center

4301 Airport Highway

Toledo, OH  43615

TIME

9:00–11:00 am
9:00–10:00 am

Long-term Disability Products & Contracts

10:00–11:00 am

Voluntary Insurance Benefit Programs

RSVP

SHogan@crnstone.com

PLEASE NOTE: The class offered in Lima has been cancelled.

This Month’s Updates from UnitedHealthcare

Changes to UnitedHealthcare’s Prescription Drug List (PDL)

Brokers and clients are invited to view UnitedHealthcare’s pre-recorded PDL presentation of the pharmacy benefit strategies that take effect July 1, 2019.

Access the presentation here.

Updates include:

  • Value- and outcomes-based contracting
  • Industry pricing dynamics
  • Continuous coverage evaluation and updates
  • Revisited PDL exclusions for ASO clients
  • Additional PDL pharmacy benefit updates
  • Clinical program updates

Fitbit Charge 3 Now Syncs with UnitedHealthcare Motion

Eligible UnitedHealthcare Motion participants now have the option to use the Fitbit Charge 3.

  • If a Motion participant already owns a Fitbit Charge 3, they may pair their existing device by visiting unitedhealthcaremotion.com and begin walking to earn rewards.
  • Those who don’t own a Fitbit Charge 3 will be able to purchase one via the Motion website.

Real Appeal Info Sessions

Real Appeal will host webcast information sessions once a month throughout 2019 for customers to learn more about the digital weight-loss program, how to register their company, and start offering this benefit to their employees.

Click here to view the schedule and register for the webcasts.

What’s New From Anthem: Paperless EOBs, the Anthem Anywhere App, and LiveHealth

Anthem’s Paperless EOB Process

Anthem will no long mail paper explanation of benefits (EOB) to clients for vision services.

  • At the time of service, members will get a receipt that shows their costs for vision services, similar to what they experience when they pick up a prescription at a drugstore.
  • When they get vision care outside their plan network, they’ll still get a breakdown of costs and what they pay, along with any reimbursement check.
  • At any time, members can go online to anthem.com and see how their claims were paid.
  • And if they want a copy of their EOB sent to them by mail or email, they can simply call the number on their member ID card and ask for it.

The Anthem Anywhere App

The redesigned Anthem Anywhere app enables clients to access their health plan information from their mobile device. A couple improvements on the app:

  • A new home page dashboard gives members quick access to key information, like benefits and claims — plus a quick snapshot of what they’ve spent so far.
  • Quick ID card access from home page.
  • One tap directs members from home page to sections on finding care and estimating costs.
  • Easier to check and update profile information.
  • Easy access to other health apps, like Engage, where applicable.

LiveHealth Online Allergy Campaign

Starting April 22, LiveHealth Online kicks off two campaigns to increase overall registration and to raise awareness about the LiveHealth Online Allergy practice. Among members already registered for the app, the allergy campaign targets some with and without past allergy claims, just to remind them how the allergy practice can help.

The registration campaign is a series of communications (emails, phone calls and a direct mail piece) going to group members, encouraging them to register for LiveHealth Online. The campaign targets members 18 years or older, who have not already registered for LiveHealth Online. Anyone who creates a LiveHealth Online account during the campaign is entered in a chance to win a $500 Amazon gift card.

Contact your Cornerstone representative with any questions.