EmployerMatters

Employer Advisory Group Meeting Key Point Summary

Posted on December 3, 2014

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Meeting Date: 11/18/14stock4-puzzle-piece-770-529

Health Management Program

  • Review and Updates: Member and Employer Wellness programs.
  • Feedback Needed: Challenges and Ideas for Program Implementation.
  • Proposed Focus Groups at Employers: What challenges employees encounter in starting or staying with a wellness program?
  • Suggestions from Employers: hypnosis for weight loss, more wellness materials, programs  that focus on mindfulness for wellness, motivating employees, assistance to keep the programs going due to resource constraints.

Enrollment & Reconciliation Specialist

• HNE Direct: Helping members and employers with questions
• Thoughts and suggestions for a better user experience

Impacts of ACA

All groups:

  • Adult dependents up to age 26 will be covered through their birth month, not their birth date.
  • Waiting periods for new hires can be no longer than 90 days.
  • HNE will prepare Summaries of Benefits and Coverage and the employer will distribute to employees at open enrollment and upon request.
  • ACA allows premium differentials to those who participate in an outcome-based wellness program or smoking cessation program.
  • HIPAA certificates of credible coverage are no longer required after 12/31/14. HNE will send termination letters to terminated members instead.

Large groups:

  • Employer Notice of Exchange – Employers need to provide notice to employees and new hires that they can obtain coverage through the exchange.
  • Play or Pay Mandate Reporting – Employers with 51+ eligible employees must make an offer of coverage to substantially all full time employees and their dependents that meets Minimal Essential Coverage and is deemed affordable. HNE will file membership for fully funded groups. Applicable Large Employers should be working with their payroll vendors to prepare to file Forms 1094-c and 1095-c with the IRS for calendar year 2015.
    –     Dependents include children and stepchildren, but not spouses.
    – An average of 120 worked hours per month is considered a full time employee.
    – Six through twelve consecutive months can be used for a look back period if an employer      needs to set up measuring periods to determine who is a full-time employee.

ASO groups:

  • PCORI fees are going up (10/2014 – 9/2015) from $2.00 to $2.08 per covered life. Health Reimbursement Accounts are included since they are considered self funded plans. The fee is due 7/31/16.
  •  Transitional reinsurance fees – scheduling of payment and submission of supporting documentation have been extended to 12/5/14. Payment due dates are the same.
  • ASO groups do not need to get HPID (Health Plan Identifiers). This requirement is under review by CMS.
  •  In Massachusetts, ASO plans need to certify to HNE that the plan meets Minimal Creditable Coverage if HNE does not cover all benefits. HNE will send out 1099-HCs.

Small groups:

  • If participation rules aren’t met, employers and individuals can go through open enrollment at the same time.

Categories: Healthcare Reform

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