DDI Benefits Newsletter | March 2015

After 5 years, we are still trying to implement and comply with the PPACA approved in 2010 by President Obama. There have been many provision changes and delays and lots of confusion. However, more Americans have health insurance, plans are richer in coverage overall, and awareness about the importance of health insurance is at an all-time high! Our team at DDI is committed to helping you understand your options and compliance requirements, as well as being your advocate when you need to use your health insurance plan. Our March Enewsletter includes important reform reminders especially focused on Employer group plans. Thank you for choosing DDI!

Special Enrollment Period for Marketplace:
March 15- April 30, 2015

On February 20, 2015, the Centers for Medicare & Medicaid Services (CMS) announced a special enrollment period for individuals and families who did not have health coverage in 2014 and are now subject to the “shared responsibility payment” (a.k.a. individual mandate penalty) when they file their 2014 tax returns. This special enrollment period applies specifically to individuals who live in states which use the Federally Facilitated Marketplaces (FFM).

This special enrollment period provides individuals who were not aware of their responsibility to have minimum essential coverage (MEC) the opportunity to enroll in coverage for themselves and their families through a FFM from March 15 – April 30, 2015. While it doesn’t impact state-based Marketplaces, states may choose to offer the special enrollment period as well.

Who is eligible?

• Individuals who live in states with a FFM and are not currently enrolled
  in 2015 coverage (Oregon is now with FFM),
• Individuals who confirm that when they filed their 2014 tax returns they
  paid the fee for not having MEC in 2014, and
• Individuals who attest they first became aware of the individual mandate
  requirements after the 2015 open enrollment period (i.e., after February
  15, 2015).

Tax season insights

Because this is the first tax season when consumers must declare having MEC, CMS recognizes that tax payers are either first becoming aware of their responsibility or confused by whether or not they qualify for exemption. CMS has launched a tool to help consumers determine if they qualify for an exemption, which is posted on Healthcare.gov: health coverage tax exemption tool.

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Health Reform Checklist (reminders) for employers:

Since 2010 when the ACA became official, we have communicated regularly about the various new provisions affecting employer sponsored health plans.  Below is a helpful checklist of items that must be in place on your group plans in 2015.  As your plans renew DDI will work with you to make sure your specific plan meets these requirements. As always, contact us with any questions. Click the graphics below to get the full PDF from Cigna.

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Final Instructions for IRS Reporting RE: Individual and Employer Mandates

On February 9, 2015, the Internal Revenue Service (IRS) released final forms and instructions for reporting on individual and employer mandates. The instructions and forms will be used by applicable large employers, insurers and employers with self-insured plans.

The Final Rules on Minimum Essential Coverage (MEC) and Large Employer reporting were released on March 5, 2014. The first reporting is required in early 2016 for the 2015 calendar year. Employers had the option to voluntarily report 2014 information by January 31, 2015 for the 2014 calendar year.

What the Instructions Cover

The instructions provide an overview of why the forms/reporting are required. They also cover basic information including:

• who must complete the forms
• how the transmittal forms need to accompany their respective 1095-B or
  1095-C Forms
• where to mail paper forms; details for filing electronic forms are expected
  when the IRS posts Publication 5165
• specific line by line instructions
• general directions for contact person, signature on form and phone number
• definitions of various terms used in reporting data
• minimum guidance on multi-employer arrangements
• transitional relief for off-calendar year plans

Required Forms

There are two forms required for each set of information being reported: 1) a transmittal form that serves as a cover letter; and 2) forms providing data on either the individual or employer mandate, or both for self-insured employer sponsors. The instructions and respective forms to be completed and filed are as follows:

Instructions  for employers to file Form 1094-C  (a transmittal/cover sheet) to the IRS only, and Form 1095-C  to both the IRS and named individuals. If its plan is insured, the employer will only complete Parts I and II of Form 1095-C.

Instructions  for insurers to send Form 1094-B  (a transmittal/cover sheet) to the IRS only, and Form 1095-B  to both the IRS and
named individuals for insured coverage only.

These instructions and forms can be found on the IRS website

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For more information on creating a customized benefits package for your employees, contact DDI Benefits at 503.206.5654, or via email to dena@ddibenefits.com