DOL Proposes Major Changes to Annual Reporting Requirements for Health Plans

Authored by Dannae L. Delano

Jul 18, 2016

Major changes to annual reporting requirements for health plans are in the works. Group health plans of all sizes, including those with fewer than 100 members that are currently exempt from reporting requirements, will be required to file more information.

The changes proposed by the Department of Labor and the Internal Revenue Service will require an updated IRS Form 5500 and a new schedule J, designed to finally implement the Affordable Care Act transparency requirements.

The proposed rule implements Schedule J to collect the following information:

  • the approximate number of participants and beneficiaries covered under the plan at the end of the plan year;
  • the number of persons offered and receiving COBRA coverage under the plan;
  • whether the plan offers coverage for employees, spouses, children, and/or retirees, and what type of group health benefits are offered under the plan;
  • whether the benefit is insured and whether benefits are paid from a trust or from the general assets of the employer;
  • whether there are participant and/or employer contributions;
  • any prototype information, if applicable;
  • whether any benefit package options are grandfathered;
  • whether a plan is a high deductible health plan, a health flexible spending account, or a health reimbursement account;
  • whether a plan received rebates, refunds, or reimbursements from a service provider, including medical loss ratio rebates, the amount of rebates, and how rebates were used;
  • identifying information for service providers to the plan;
  • total premium payments made, attachment points, individual claim limits and aggregate claim limits for any stop loss coverage;
  • for self-funded health plans, information regarding employer and participant contributions and the timely transmittal of any participant contributions;
  • paid and unpaid claims data;
  • the total dollar amount of claims paid for the plan year; and
  • if the plan was insured, any delinquent payments to the insurance carrier within the time required by the insurer and whether any delinquencies resulted in a lapse.

The proposed Schedule J further contains a compliance section that would ask:

  • if plan assets were held in trust or held by a qualified insurance company or under allowable insurance contracts, except where plan assets are not required to be held in trust;
  • whether the plan’s summary plan description (SPD), summaries of any material modifications (SMM), and summary of benefits and coverage (SBC) comply with applicable content requirements;
  • whether coverage provided by the plan is compliant with applicable federal laws and regulations including the portability and nondiscrimination requirements of HIPAA, GINA’s prohibitions against genetic information discrimination, mental health parity requirements, and protections of the Newborns’ and Mothers’ Health Protection Act of 1996, the Women’s Health and Cancer Rights Act of 1998, Michelle’s Law, and the Affordable Care Act.

If you have any questions about the proposed changes to the Form 5500 for health and welfare plan annual reporting purposes or any other employee benefits matter, please do not hesitate to contact Dannae Delano.

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