Get Up to Date on Reporting Requirements

Do you have questions about compliance? The implementation of the Affordable Care Act has created a new web of regulations for employers providing health insurance to employees in addition to the compliance requirements of federal and state labor laws. Applicable Large Employers or ALEs have the shared responsibility provision and the employer information reporting from the Affordable Care Act. Self Insurers have additional reporting requirements.

Here is a list of some of the basics for reporting and filings along with some websites that provide more detail and information on what is required, new and changing. PAA (Health Insurance Portability and Accountability Act)

 

1. SPD & Basic Notices and Filing
The SPD or summary plan description is an easy to ready statement describing the provisions and features of the benefits plan including eligibility.

https://www.dol.gov/sites/default/files/ebsa/about-ebsa/our-activities/resource-center/publications/rdguide.pdf

 

2. Summary Plan Description, Form 5500 – For 5500
The Form 5500 Series is part of ERISA’s overall reporting intended to assure that employee benefit plans are operated and managed in accordance with certain prescribed standards.

https://www.irs.gov/retirement-plans/form-5500-corner

 

3. Summary of Benefits Coverage
Under the law, insurance companies and group health plans will provide consumers with a concise document detailing, in plain language, simple and consistent information about health plan benefits and coverage.

https://www.cms.gov/cciio/programs-and-initiatives/consumer-support-and-information/summary-of-benefits-and-coverage-and-uniform-glossary.html

 

4. COBRA
The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss.

https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/cobra

 

5. HIPAA
The Health Insurance Portability and Accountability Act is set up to make it easier for people to keep health insurance and protect the confidentiality and security of healthcare information as well as help the industry control administrative costs.

http://www.hhs.gov/hipaa/for-professionals/index.html

 

6. Notice of Pre-existing Condition Exclusion, Certificate of Creditable Coverage, Wellness Program Disclosure
A key protections under HIPAA , it helps those with preexisting conditions get health coverage.

https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/faqs/hipaa-consumer

 

7. Women’s Health and Cancer Rights Act Notices, Mental Health Parity and Addiction Equity Disclosure
This provides protections for individuals who want reconstruction after a mastectomy.

https://www.dol.gov/general/topic/health-plans/womens
https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/mhpaea_factsheet.html

 

8. Other ACA and compliance Notices:
These are various notices that companies must deliver when they provide health care to employees.

  • Special Health Care Notices
  • Health Care Reform Notices

 

Useful Sites for General Information:

1. Patient Protection and Affordable Care Act (PPACA) Site
This is the main site for ACA information.

Https://www.healthcare.gov/

 

2. Department of Labor
This is a Department of Labor resource for employee benefits as they relate to the Affordable Care Act.

https://www.dol.gov/ebsa/healthreform/

 

3. Kaiser Family Foundation

Kaiser is a non-profit organization focusing on national health issues.

https:/kff.org/health-reform/

 

4. IRS and Affordable Care Act
Found on the Internal Revenue Service site, ACA requirements can be found here as it relates to larger employers.

https://www.irs.gov/affordable-care-act/employers/aca-information-center-for-applicable-large-employers-ales