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The Wagner Law Group Description 

The Wagner Law Group, A Professional Corporation, is a nationally recognized ERISA & employee benefits, estate planning, employment, labor & human resources practice. 

 

Established in 1996, The Wagner Law Group has 22 attorneys engaged exclusively in employee benefits, estate planning and employment law. Six of our attorneys are AV rated by Martindale-Hubbell as having very high to preeminent legal abilities and ethical standards. The firm is among the largest ERISA boutiques in the country. Our practice is national in scope, with clients in more than 40 states and several foreign countries.

 

 

 

 

 

Contact Info

The Wagner Law Group

 

  Integrity | Excellence

  

Massachusetts Office 

Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110


Florida Office 

Tel: (561) 293-3590
Fax: (561) 293-3591
7108 Fairway Drive
Suite 125
Palm Beach Gardens, FL 33418

   

San Francisco Office

Tel: (415) 625-0002

Fax: (415) 358-8300

315 Montgomery Street

Suite 904

San Francisco, CA 94104

 

www.wagnerlawgroup.com

 

 

 

 

October 29, 2014

 

 Health and Welfare Law Alert

 

 

 

 

 

Affordable Care Act's Reinsurance Fee Deadline Rapidly Approaching 

 

 

 

The Patient Protection and Affordable Care Act ("ACA") requires insurance issuers and self-funded group health plans to pay a fee to HHS to fund the Transitional Reinsurance Program (the "Program"). These fees, which are based on the total number of covered lives during the calendar year, are payable to HHS starting in 2014 and ending in 2016. Self-funded group health plans must register and provide annual enrollment data for the 2014 calendar year to HHS no later than November 15, 2014.

 

Background. The ACA established the Program to stabilize premiums in the individual market inside and outside of the Health Insurance Marketplaces. The Program will collect contributions from insurers and self-funded plans for the 2014, 2015 and 2016 calendar years. These contributions will be used to fund the Program's administrative costs and to help insurers pay for the high-cost enrollees that they must cover because of the ACA's guaranteed-issue and no-rescission rules.

 

Health insurance issuers and self-funded group health plans providing major medical coverage must pay reinsurance fees based on the total number of covered lives during the calendar year. Insurers are responsible for making reinsurance fee payments for insured plans and plan sponsors are responsible for making reinsurance fee payments for self-funded plans. Plan sponsors may use a third party administrator ("TPA") to calculate the total number of covered lives and remit payments to HHS.

 

Exemption from Reinsurance Fee. For 2015 and 2016, a self-funded group health plan is exempted from paying reinsurance fees if it does not employ a TPA to perform the plan's core administrative functions (i.e., claims processing and plan operations). To qualify for this exemption, a self-funded plan cannot use the TPA for more than 5 percent of the plan's core administrative functions. This is a narrow exemption, and HHS expects that few plans will meet this requirement.

 

2014 Deadlines. For the 2014 calendar year, self-funded plans must calculate the total number of covered lives and provide enrollment data to HHS by November 15, 2014. (See the Alert of 3/14/13 for information on approved methods for calculating the number of covered lives for a calendar year.)

 

Self-funded plans will pay the 2014 reinsurance fees in two installments. The first installment will be invoiced by HHS by December 15, 2014, and the second installment will be invoiced during the fourth quarter of 2015. Payments are due within 30 days of the date of the invoice. Plans may opt to pay the 2014 reinsurance fee amount in one payment, no later than January 15, 2015.

 

Registration and Payment. The steps for registering with HHS and paying the reinsurance fee are as follows: 

  • Go to https://www.pay.gov/public/form/entry/101/#
  • Enter basic entity information, contact information, annual enrollment counts for 2014, and information for the plan's designated bank account from which the fee payment will be made (NOTE: the fee amount will automatically be calculated).
  • Select whether the plan will pay in one or two installments and select payment dates.
  • Payment will be automatically deducted from the plan's designated bank account on the selected dates.

 

 

 

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This Newsletter is provided for information purposes by The Wagner Law Group to clients and others who may be interested in the subject matter, and may not be relied upon as specific legal advice.  This material is not to be construed as legal advice or legal opinions on specific facts. Under the Rules of the Supreme Judicial Court of Massachusetts, this material may be considered advertising.