It’s been busy recently for the federal government when it comes to implementing various health reform requirements. Here’s an overview of new guidance issued the week of Feb. 25-March 1 on health insurer fees, market reforms, the Small Business Health Options Program, multiple employer welfare arrangement regulation and information reporting.
Self-insured Health Plans Exempt from New Fees, but Certain MEWAs Are Not
Health reform guidance explaining the imposition of new annual fees on covered entities that provide health insurance was issued by IRS. Self-insured group health plans are excluded from these new proposed regulations, but certain multiple employer welfare arrangements and retiree-only plans are not exempt.
Effective in 2014, an annual fee is to be imposed on covered entities engaged in the business of providing health insurance. The proposed rules provide more details on the mechanics of this fee process and the types of entities that must comply. Generally, a covered entity would include entities such as health insurance issuers; HMOs; Medicare Advantage, Medicare Part D, or Medicaid insurers; and non-fully insured MEWAs. Exempt entities include self-insured group health plans, fully insured MEWAs and certain fully insured Entities Claiming Exception (entities that claim not to be MEWAs because they are established based on collective bargaining agreements).
HHS Clarifies Employer Plan Issues in Temporary Reinsurance, Market Reform Rules
The U.S. Department of Health and Human Services issued final regulations on various health insurance market reforms. For example, the reform law establishes several premium stabilization programs to help protect against adverse selection health insurance exchanges are implemented. One program on transitional reinsurance will help states stabilize premiums for individual market coverage from 2014 through 2016. Among other things, HHS clarified how self-insured plans and third-party administrators are affected by this program and which type of benefits — like health flexible spending arrangements — are exempt.
Small Business Health Options Program
The HHS market reform rules also clarify and expand upon standards for the Small Business Health Options Program, which states can set up to offer qualified health plan options for small businesses. A separate proposed rule would amend existing regulations on triggering events and special enrollment periods and would implement a transitional policy for employees’ choice of QHPs.
More Oversight Over MEWAs
The U.S. Department of Labor issued final rules to implement its authority under health reform to crack down on noncompliant and/or financially unstable MEWAs. The new rules give DOL the authority to issue cease-and-desist and summary seizure orders when a MEWA engages in fraudulent conduct or is in a financially hazardous condition.
More Reporting Obligations for MEWAs
In another step to crack down on MEWA abuses, DOL also finalized regulations that require all MEWAs to submit to registration and annual reporting requirements. These final rules amend: (1) existing Form M-1 reporting rules by incorporating new provisions enacted as part of the health reform law; and (2) existing Form 5500 annual reporting rules for ERISA-covered plans subject to the Form M-1 rules. The final rules also apply to certain ECEs.
DOL Revamps Form M-1 Due to New Rules; 2012 Filings Extended
DOL also issued a notice announcing that a new, “substantially different” Form M-1 is now available, and that entities have more time to file the 2012 form in light of the changes. The revisions can be viewed on the EBSA website. A Self-Compliance Tool will continue to be included in the Form M-1 instructions.
DOL Revises Annual Form 5500 to Reflect MEWA Rules
Finally, DOL issued revisions to Form 5500 filing rules for employee welfare benefit plans that not only align all the regulatory language but give the agency more enforcement power against small plan MEWAs and ECEs. The DOL notice announced that the Form 5500 will be revised to include new Form M-1 compliance questions and requires all plans that must file Form M-1 to also file a Form 5500, regardless of the plan size or type of funding.
More details on the new health reform guidance can be found in hrcomplianceexpert.com.