DID YOU KNOW
On May 28, 2013, the IRS released an
updated Form 720 that includes a section where issuers and self-funded plan
sponsors will report and pay the Patient-Centered Outcomes Research Institute (PCORI)
The PCORI fees apply for plan years
ending on or after Oct. 1, 2012, but do not apply for plan years ending on or
after Oct. 1, 2019. For calendar year plans, the fees will be effective for the
2012 through 2018 plan years.
The first deadline for filing Form 720
is July 31, 2013.
HCR Final Rule on Workplace Wellness Programs
The Affordable Care Act (ACA) includes
provisions to encourage appropriately designed, consumer-protective wellness
programs in group health coverage.
Effective for plan years beginning on
or after Jan. 1, 2014, ACA essentially codifies the existing HIPAA
nondiscrimination requirements for health-contingent wellness programs, while
also increasing the maximum reward that can be offered under these programs.
Changes for health-contingent wellness
programs include an increase in the permissible reward for meeting a
health-related standard to 30 percent of the total cost of employee-only
coverage (or 50 percent, if the program is designed to prevent or reduce
The final regulations formally adopt
the proposed nondiscrimination rules for these programs, such as giving
individuals an opportunity to qualify
for the reward each year and providing an alternative standard or waiver for
individuals with health conditions.
The rules also divide these programs
into two categories—activity-only wellness programs and outcome-based wellness
The final rules will also continue to
support participatory wellness programs, which are generally available without
meeting a health-related standard.
These programs include programs that
reimburse for the cost of membership in a fitness center, that provide a reward
to employees for attending a monthly, no-cost health education seminar, or that
reward employees who complete a health risk assessment, without requiring them
to take further action.
Employer Coverage Tool Released
HHS has released application forms for
individuals seeking health insurance coverage through an Exchange, along with
the Employer Coverage Tool, which is intended to assist employees in gathering
information about their employer’s health coverage.
The Employer Coverage Tool asks for information
on the health plan’s eligibility requirements, waiting periods and premium
costs, along with whether the plan provides minimum value and whether any
changes will be made to the plan for the new plan year.
Employees will use this information to
complete the Exchange application and to determine their eligibility for
Employers should familiarize
themselves with the Employer Coverage Tool so they can provide accurate and
complete information regarding their health coverage in order to avoid paying
Pay or Play penalties.