DDI Benefits Newsletter | October 2014

Medicare D Notice and Filing Reminder

 All employers, large and small, who offer prescription drug coverage are required to inform their employees and CMS if their prescription drug plan is medicare creditable by October 15, 2014.  This deadline is a result of the annual enrollment period for Medicare which is October 15 – December 7th each year. Even if you are unsure of medicare eligibility it is recommended to provide this notice to your benefit eligible employees and their dependents.

Please click here for the full explanation of the Medicare Modernization Act’s requirements as well as model notices of the required forms. Any members (including dependents) who are eligible or will be eligible within the next year for Medicare must receive the notice. Employers must also notify CMS via their online form as to whether their plans are or are not  creditable.

According to CMS:

This disclosure must be provided to Medicare eligible active working individuals and their dependents, Medicare eligible COBRA individuals and their dependents, Medicare eligible disabled individuals covered under your prescription drug plan and any retirees and their dependents. The MMA imposes a late enrollment penalty on individuals who do not maintain creditable coverage for a period of 63 days or longer following their initial enrollment period for the Medicare prescription drug benefit.

Click here to download the model notice letters you can customize and send to employees.

If you are unsure whether your plan is creditable or not, please contact your health insurance carrier or DDI. Most carriers recently sent notices to clients indicating if the plan was creditable.

PLEASE NOTE:

If you are a DDI Administration / Outsourcing client, we are sending this letter to your employees on your behalf.

Please call us with any questions.

2015 Health Care Reform Reminders

2015 Open Enrollment Checklist for Employers

Cost Sharing:

• In-network out of pocket maximums cannot exceed $6600 individual and $13,200 family.
• All in-network copays, deductibles and coinsurance for essential health benefits (EHBs) provided through the same carrier/vendor must accumulate to a single OOP maximum.

Preventive care:

• Preventive care, including the additional women’s preventive care services that took effect in 2012 must be covered at 100%.

Doctor choice:

• Individuals can choose any doctor as their primary care physician and see an OB-GYN without a referral.

Emergency care:

• Emergency care must be covered at the in-network level, even if received from an out of network provider.

Wellness programs and rewards:

• The maximum wellness program reward is 30% of the total cost of medical coverage, including both employer and employee contributions. The maximum reward may be increased to 50% for programs related to tobacco use.  Rewards can be provided through premium discounts or surcharges, reduced costs of enhanced benefits.  If an individual does not qualify for a health-contingent reward, a reasonable alternative standard or waiver must be available.

Health Insurance Marketplace notice:

• Employer must provide a notice about the Health Insurance Marketplace to all new employees.  The notice must be provided regardless of company size, whether the employer offers health coverage or whether the employee will be eligible for health coverage from the employer.

Summary of Benefits and Coverage (SBC):

• This standardized benefit summary must be proved with enrollment materials when an individual enrolls for the first time, for each new plan year and upon request. The 2014 SBC template is the most current version available.

Individual Mandate:

• Effective January 1, 2014 all individuals (with a few exceptions) are required to have “minimum essential coverage” or pay a penalty.  Employer coverage, a government plan such as Medicare or Medicaid, or individual health insurance meets this requirement.

Employer Mandate:

• Employers must offer health coverage to full-time employees and their children up to age 26, or face penalties.  This applies to employer with 100 or more full-time employees in 2015 and expands to include employers with 50 or more full-time employees in 2016 The coverage must be “affordable”
  and provide “minimum value.”

• “Affordable” means that the employee-only contribution for the lowest-cost plan is no more than 9.56% of an employee’s W-2 wages.
• “Minimum value” means that the plan pays for at least 60% of covered health services.

Employer Mandate and Individual mandate reporting:

• In early 2016, employers must report information to the IRS and to employees about how the health coverage they provided in 2015 met the employer mandate requirement.
• Information about how coverage met the individual mandate must also be reported to the IRS and individuals in early 2016.  Insurers are responsible for
  this reporting for insured plans.  Employers are responsible for reporting for self-funded plans.

DDI is committed to help you sort through the myriad of reform changes and compliance requirements. Please contact us at any time with questions