HEALTH REFORM ADVISORY PRACTICE

Presented by

Mark Holloway, J.D. Compliance Services, Lockton Benefit Group © Lockton Benefit Group 2015

Here We Go Again

Navigating the Online System for Paying the Transitional Reinsurance Fee (TRF)

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HEALTH REFORM ADVISORY PRACTICE

Presented by

Mark Holloway, J.D. Compliance Services, Lockton Benefit Group © Lockton Benefit Group 2015

Here We Go Again

Navigating the Online System for Paying the Transitional Reinsurance Fee (TRF)

To View Webcast, Click Here

Agenda

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Agenda

Background on Transitional Reinsurance Fees (TRFs)

What’s New for 2015?

Eight-Step Program for TRF Form Completion

Helpful Resources from Uncle Sam

Questions

Background: TRF

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Transitional Reinsurance Fee

TRF = annual per capita fee

$44 per enrollee for 2015 ($63 for 2014)

$27 per enrollee for 2016

Funds Transitional Reinsurance Program

Established under Affordable Care Act (ACA) to help stabilize premiums in the individual market

Administered by Centers for Medicare and Medicaid Services (CMS)

CMS calls TRF “reinsurance contributions”

Required for 2014, 2015 and 2016 calendar years

CMS calls these “benefit years”

TRF 101

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Which Employer Plans are Subject to the TRF?

TRF applies to employer-sponsored health plans providing minimum value (MV) coverage

Plan = ERISA definition (without the church and governmental exclusions)

MV = Same meaning as for play or pay

MV Coverage: 60% actuarial value

Use MV calculator to determine whether coverage is MV

In some cases, may need an actuarial certification of value

Self-funded employers will owe the fee

TPA can pay on behalf of plan and invoice the employer

Employer can pay the fee itself

That’s what we’ll discussing here . . .

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Who is Responsible for Filing and Remitting?

Structure TRF Required? Who Files and Remits TRF? Enrollees Excluded from Being Counted

Insured MV Plan (Employer provides NO self-insured health benefits other than disregarded benefits*)

Yes Insurer

• Those not actually covered by MV medical coverage on the counting date (e.g., only covered for dental, vision or EAP benefits)

• Those covered by Medicare for whom Medicare is primary

• Those covered by an individual policy for which TRF is being paid

• Those covered by another employer plan that is primary

• Those covered by expatriate health insurance

• Individuals whose primary residence is in a U.S. Territory

* Disregarded benefits include:

• Integrated health reimbursement account (HRA)

• Health flexible spending account (FSA) offered under a cafeteria plan

• Health savings account (HSA)

• Prescription drug coverage

• Optional dental or vision coverage

• On-site clinic

• Dread-disease/specified illness insurance

• Hospital or other fixed indemnity insurance

• Medicare or TRICARE supplement insurance

• Other excepted benefits

Self-Funded MV Plan (Employer provides NO insured health benefits other than disregarded benefits*)

Yes Plan Sponsor

Plan with Self-Funded MV Option and Insured MV Option (No benefits available in addition to the MV options other than disregarded benefits*)

Yes

Plan Sponsor for Self-Funded MV

Options

Insurer for Insured MV

Options

Multiple Employer-Sponsored Plans Simultaneously Providing Coverage to a Single Individual

Yes, if combined coverage is MV

Varies – CMS rules determine

Disregarded Benefits* No

What’s New for 2015

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Fee is $44 for 2015 (vs. $63 in 2014)

Supporting documentation (.csv file) for the TRF submission only required if submitting contributions for four (4) or more plans

Unusual that an employer would submit for that many plans

Practical impact—insurers and TPAs will may need to attach supporting documentation, but most employers will be exempt

Contributions are not required from a self-insured group health plan that does not use a TPA in connection with claims processing or claims adjudication (including the management of internal appeals) or plan enrollment (ditto for 2016)

Concession to Taft-Hartley plans

Differences In TRF Process for 2015

CMS’s Eight-Step Program

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By November 16, 2015 . . .

CMS Diagram of Online Process

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Step 1: Before Getting Started

Determine annual enrollment count (using an approved method, rounded to nearest hundredth) for the 2015 calendar year

Enrollment is measured on a calendar year basis no matter what your plan year is (exception: using 5500 method for annual enrollment count)

Not even really a calendar-year basis—use the enrollment counts from the first 9 months of 2015 as a proxy for enrollment throughout 2015

Four methods available

Actual count on each day January 1 - September 30, 2015 divided by number of days

Actual count on at least one day during each of the first three calendar quarters of 2015 divided by the number of days on which counts were taken

Same number of days must be used each quarter

Day(s) chosen for each quarter must correspond to one another and be within the same week

Using the same method to choose days for counting, add together:

Actual count of participants with self-only coverage

2.35 multiplied by actual count of participants with other than self-only coverage

From most recently filed Form 5500, items 5 and 6, add together number of participants at beginning of plan year and number at end of plan year

If plan provides no dependent coverage (only coverage available is self-only), divide total by 2

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Step 1: Before Getting Started

Count ALL covered individuals who have MV coverage under the plan for which employer is filing

Employees, contractors, directors, staffing agency workers, etc.

Retirees (but may be able to exclude some for whom Medicare is primary)

Spouses, children, domestic partners, etc. of any of the foregoing

Do not count covered enrollees whose MV coverage is:

Secondary to Medicare under MSP rules (individual must actually have at least Part A in effect to be excluded)

Secondary to another employer’s plan for which TRF will be paid (probably need a written acknowledgement from the other plan)

In addition to individual market coverage for which TRF will be paid

Expatriate insurance coverage

Do not count enrollees residing in US territories

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Step 2: Navigate to Form on Pay.gov

Note: you had to register at pay.gov last year for the 2014 filing

If you haven’t logged into pay.gov since 2014, you will be prompted to change your password

Information needed for the 2015 form includes:

Name and contact information for the person who will be entering the information throughout the process

Needs to be someone who can discuss the information submitted on the Form and supporting documentation (including enrollee count reported)

Legal business name and employer identification number of plan sponsor

Plan sponsor is identified on Form 5500

Important to verify the EXACT legal business name that goes with the EIN

Complete the Pay.gov registration with that exact legal business name (EIN won’t be needed for registration)

“Billing address” of the plan sponsor

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Registering On Pay.gov

Go to www.pay.gov, click on “Register”

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Step 2: Navigate to Form On Pay.gov

Once registered, log in to Pay.gov website (https://pay.gov)

In search box at bottom of page, search for “2015 ACA Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form”

Once found, select “Continue to the Form”

Then “Acknowledge Payment Method” in order to navigate to the form itself

Only option for payment is ACH (pull from bank account)

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Step 3: Completing TRF Form—Contact Information Information Needed To Complete the Form on Pay.gov

Legal business name of plan sponsor (auto-populates from Pay.gov)

Plan sponsor EIN

Billing contact information

Billing address (auto-populates from Pay.gov)

“Contact for Submission”

Auto-populates from Pay.gov with information of person completing the Form

Only one “contact for submission” required for 2015

2014 form required two more individuals be designated

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Step 3: Completing TRF Form—Contact Information Sample Completed Form—Contact Information

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Step 3: Completing TRF Form—Contact Information

Next come the following two questions:

“Are you reporting more than three (3) Contributing Entities?”

“Are you both the Reporting Entity* and Contributing Entity**?”

If the employer is submitting the TRF form for its own plan, answer “yes”

If you checked “yes” to the question “Are you reporting more than three (3) Contributing Entities?” then you will also need to upload supporting documentation later

* Contribution entity means the health plan subject to the TRF **Reporting entity means the entity (employer) actually filing the TRF

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Step 4: Completing TRF Form—Contributing Entity Information

Enter information noted on the form noted below and either continue, save or preview

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Step 5: Complete Contributions Form

Need to select “New” for “Type of Filing”

Select “Type of Payment”

First collection – pay $33.00 per enrollee no later than January 15, 2016

Second collection – pay the remaining $11.00 per enrollee by no later than November 16, 2016

Later, you must duplicate the first collection form and complete a second submission to schedule payment for second collection

OR Combined collection - pay full $44.00 per enrollee no later than January

15, 2016

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Step 5: Complete Contributions Form

Select “2015” from drop-down menu and enter and verify total determined using approved counting method as “Annual Enrollment Count”

Round to the nearest hundredth (e.g., 68.75, not 68.74825)

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Step 5: Complete Contributions Form Acknowledgment and Authorizing Official Information

After entering count, TRF is calculated

To complete the Form:

Must check a box next to a verification statement

“The Gross Annual Enrollment Count entered in this form matches the aggregate enrollment count by entity in the supporting documentation, if applicable.”

Must check a box next to an acknowledgement statement

“Acknowledgment: My acknowledgment is on behalf of my organization and the contributing entity or entities for which the data and accompanying payment(s) are being submitted. My acknowledgment legally and financially binds my organization and each contributing entity to the applicable laws, regulations and program instructions of the Affordable Care Act (ACA). By my submission, I certify that the data are true, correct and complete. If my organization or any contributing entity becomes aware that data are untrue, incorrect or incomplete, CMS shall be promptly informed. If CMS identifies a discrepancy or has questions about the data being submitted, I agree to be the contact for responding to such questions. I acknowledge that the provisions of the Affordable Care Act specifically make payments made by or in connection with an Exchange subject to the False Claims Act if those payments include any Federal funds. This includes, but is not limited to, the transitional reinsurance program established under Section 1341 of the Affordable Care Act.”

Must provide information for an authorizing official who has authority to authorize the TRF payment and certify information is accurate and complete

CMS will contact authorizing official if it identifies a discrepancy or has questions

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Step 6: Upload Information .CSV File (if applicable)

Complete this step only if you are reporting for three or more plans (“contributing entities”)

Select “Browse,” then attach the .csv file

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Step 6: Upload Information .CSV File (if applicable)

Very nearly the same information already entered on the Form, submitted in a .CSV file format (assuming plan sponsor is reporting)

One line of 14 data elements separated by commas

Reporting Entity Legal Business Name (LBN) = Plan Sponsor LBN from Pay.gov

Reporting Entity Federal Tax Identification Number (TIN) = Plan Sponsor EIN

Contributing Entity Legal Business Name (LBN) = Plan Sponsor LBN

Contributing Entity Federal Tax Identification Number = Plan Sponsor EIN

Contributing Entity Organization Type = “For Profit” or “Nonprofit”

Contributing Entity Billing Address – Line 1 = Plan Sponsor Address

Contributing Entity Billing Address – Line 2 (optional, but leave blank if none)

Contributing Entity Billing Address City = Plan Sponsor Address City Name

Contributing Entity Billing Address State = Plan Sponsor State (2-Letter Abbr.)

Contributing Entity Billing Address Zip Code plus 4 = Plan Sponsor Zip Code

Contributing Entity Domiciliary State = Plan Sponsor State (2-Letter Abbr.)

Benefit Year = 2015

Annual Enrollment Count = Same as Gross Annual Enrollment Count on Form

Type of Contributing Entity = “SI” (or may be “MGHPM” or “MGHPS”)

Omit special characters: * < > / \ % ^ , + ? ‘ { } [ ] ! ~ & =

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Step 7: Completing TRF Form—Payment Information

Payment Information Page

Select payment date(s)

Choice of paying in a single, lump sum (“combined collection”) or in two collections

See next slide

Enter account holder name

Select checking or savings account type

Enter bank routing number

Enter bank account number

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Step 7: Completing TRF Form—Payment Information

Payment date pre-populates for the next business to pay

Must update payment date field if you wish to schedule ACH transfer for later date

No later than January 15, 2016, if either Combined Collection or First Collection

No later than November 16, 2016 if Second Collection

Must duplicate the first collection form and complete a second submission to schedule payment for second collection ($11 per capita)

See slides that follow

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Step 7: Completing TRF Form—Payment Information Scheduling Second Collection

Navigate to “View my Forms” on pay.gov

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Step 7: Completing TRF Form—Payment Information Scheduling Second Collection

Select “Duplicate” link

Then follow steps to select second collection date (see next slide)

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Step 7: Completing TRF Form—Payment Information Scheduling Second Collection

Schedule second payment date

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Step 7: Completing TRF Form—Payment Information Important Reminder—Second Collection for 2014 Due Soon

Companies that chose “second collection” for 2014 TRF will owe $10.50 per covered life by November 15, 2015

Option was to pay 2014 fee in one collection ($63) or two collections ($52.50/$10.50)

Payment date scheduled for second collection when 2014 submission count submitted

Best advice you’ll get from this webcast:

Good idea to ensure there is money in your bank account to pay Uncle Sam when the second ACH transfer hits

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Step 8: Review and Submit Payment

Review submission, below

Good idea to select “email confirmation” of transmission

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Step 8: Review and Submit Payment

Review authorization and submit payment, and you will then be prompted to print receipt (recommended)

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More sage advice: Check with your bank to see if the account is subject to an ACH debit block

If so, the bank needs an identifier so ACH transfer will not be blocked

Agency Location Code or “ALC+2”

For TRF payments: 7505008015

Same codes as 2014 submissions

Step 8.5: Ensure Your Bank Allows the ACH Transfer

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Resources On TRF From the Feds

CMS page for TRF

https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/The-Transitional-Reinsurance-Program/Reinsurance-Contributions.html

Reinsurance Contribution Submission Hotline

ReinsuranceContributions@cms.hhs.gov

Regtap (CMS portal)

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Supporting materials for TRF submission process are contained in Regtap, CMS’s portal that is “committed to providing technical assistance and training related to Marketplace and Premium Stabilization programs guidance and operations.”

https://www.regtap.info/index.php

You will need to register with Regtap if you want access to CMS’s materials posted there

Resources On TRF From the Feds

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Once registered, log in and navigate to Library

Resources On TRF From the Feds

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Filter by “reinsurance contributions”

Resources On TRF From the Feds

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Questions?

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www.lockton.com

© 2014 Lockton, Inc. All rights reserved.

Images © 2014 Thinkstock. All rights reserved.

Our Mission

To be the worldwide value and service leader in insurance brokerage, risk management, employee benefits, and retirement services

Our Goal

To be the best place to do business and to work

RISK MANAGEMENT | EMPLOYEE BENEFITS | RETIREMENT SERVICES

www.lockton.com

© 2015 Lockton, Inc. All rights reserved.