POSTED BY BETH ALCALDE &
ON NOVEMBER 6, 2014
As 2014 winds down, plan sponsors are likely thinking ahead to some of the significant changes
that will take effect in 2015, most notably, the employer "pay or play" mandate under the ACA.
However, there are two deadlines that plan sponsors of self-insured group health plans should
be aware of.
November 5, 2014 - Health Plan Identifier (Enforcement is indefinitely delayed)
All large, self-funded, "controlling health plans" were originally required to have obtained a
health plan identifier ("HPID") by November 5, 2014. Controlling health plans are those that—(1)
control their own business activities, actions, or policies; (2) are controlled by an entity
that is not a health plan; or (3) direct the business activities, actions, or policies of one
or more subhealth plans. Small health plans (defined as those with annual receipts of $5 million
or less) may take advantage of a one-year extension of the HPID deadline, to November 5, 2015.
Insured plans are also subject to the HPID requirement, however, the insurance carrier will
generally be responsible for obtaining the HPID on behalf of the plan.
HIPAA requires covered entities to use their HPIDs for all HIPAA "standard transactions." These
standard transactions include: health care claims and encounters, payment and remittance advice,
claims status request and response, eligibility and benefit inquiry and response, benefit enrollment
and disenrollment, referrals and authorizations, and premium payment transactions. There is no
charge to obtain a HPID, and it can be obtained through the CMS portal called Health Plan and Other
Entities Enumeration System (HPOES).
Please note that effective October 31, 2014, CMS announced an indefinite delay in the enforcement
of the HPID rules. Although this delay does not technically relieve plan sponsors of large, self-funded,
controlling health of their obligation to obtain an HPID and use it for HIPAA standard transactions,
the delay signifies that there will be no enforcement action taken at this time against entities that
fail to do so.
November 15, 2014 - Enrollment Numbers for Reinsurance Fees
By November 15, 2014, self-funded health plans (including non-calendar year plans) are required to
submit their enrollment data for January-September of this year to the Department of Health and Human
Services ("HHS") for purposes of the 2015 payment of the ACA's temporary reinsurance fees. This
reinsurance fee must be made for all "reinsurance contribution enrollees," a term that includes all
individuals covered by a plan for which reinsurance contributions must be made, not just employees or
CMS recently announced that the form for submitting this data will be available at www.pay.gov
in advance of this November 15 deadline. The form will automatically calculate the reinsurance
contribution amount due. HHS will then notify plans of their total reinsurance fee responsibility
for the year. For 2014 the reinsurance fee will be $63 per health care plan enrollee. This $63 annual
fee will be paid in two installments. The first installment of $52.50 per enrollee will be due by
January 15, 2015, and the second installment of $10.50 per enrollee will be due by November 15, 2015.
The reinsurance fee will be tax-deductible as an ordinary business expense.
For any questions about this blog or pending deadlines, please contact the authors.