CMS Releases Technical Guidance on the HHS-Administered Federal External Review Process

On Sep. 11, 2018, CMS issued Technical Guidance 01-2018, which updated the requirements for group health plans and health insurance issuers that are subject to the HHS-administered federal external review process.

As background, non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual coverage must comply with the applicable external review process in their state if that process meets the standard established by the National Association of Insurance Commissioners (NAIC). If the state external review process does not meet this standard, or if the plan or issuer is not subject to state insurance regulation, then those group health plans and health insurance issuers must still implement an effective external review process meeting those same standards. The Code of Federal Regulations establishes the federal external review process for this purpose.

Insured coverage not subject to an applicable state external process and self-insured non-federal governmental plans may elect to use the federal Independent Review Organization (IRO) external review process or the HHS-administered federal external review process as outlined in the guidance.

The guidance updates previous guidance (provided in January 2017) because the federal contractor that administers the process has begun to accept requests for external review through an online portal. As such, the guidance informs plans and issuers that their notices to plan participants must be updated to inform them that there are now three options for requesting an external review (mail, fax or through the online portal).

Plan sponsors who are not subject to state insurance regulation or plan sponsors located in states where the state external review process does not meet the NAIC standard can use this guidance to implement the HHS-administered external process.

HHS Technical Guidance 01-2018 »

 

Source: NFP BenefitsPartners

Filed under: Abentras Blog

IRS Publishes Updated Form 5558

The IRS recently published an updated version of Form 5558, Application for Extension of Time To File Certain Employee Plan Returns (Rev. September 2018). As background, employers use Form 5558 to request an extension of time to file Form 5500, Annual Return/Report of Employee Benefit Plan, the short Form 5500-SF and Form 5500-EZ. If filed, Form 5558 provides a 2 1/2 month extension to the due date for those forms. Form 5558 can also be filed for extensions for Form 8555-SSA, Annual Registration Statement Identifying Separated Participants with Deferred Vested Benefits, and Form 5330, Return of Excise Taxes Related to Employee Benefit Plans.

According to the “What’s New” section of the updated Form 5558, separate Forms 5558 must be filed for each type of return for which an extension is being sought. Previously, employers could file one Form 5558 to request several different return filing extensions. The updated Form 5558 also states that no signature is required when filing extension forms for Forms 5500 and 8955-SSA, but that one is required when filing extensions forms for Form 5330.

Employers should review the updated Form 5558 and familiarize themselves with the changes, particularly where they may have been filing a single Form 5558 for multiple plans in the past. The updated form should be used for Form 5558 extensions filed in September 2018 and onward.

Form 5558 (Rev. September 2018) »

Source: NFP BenefitsPartners

Filed under: Abentras Blog

IRS Releases 2018 Draft Instructions for Forms 1094-B, 1095-B, 1094-C and 1095-C

On Sept. 10, 2018, the IRS released a draft version of the instructions for Forms 1094-B and 1095-B, which are used by insurers and small self-insured employers to report that they offered MEC . These instructions are largely unchanged from the 2017 version. The one change mentioned is that insurance carriers are now encouraged (but not required) to report catastrophic health plan coverage offered through the Marketplace.

On Sept. 11, 2018, the IRS released a draft version of the instructions for Forms 1094-C and 1095-C, which are used by large employers to comply with Section 6056 reporting under the PPACA. The instructions are largely unchanged from the 2017 versions. The Plan Start Month in Part II of the Form 1095-C continues to be an optional field. Employers relying upon the multiemployer arrangement interim guidance will continue to report 1H (no offer of coverage) on Line 14 of the Form 1095-C, with Line 15 blank and code 2E on Line 16.

The forms must be filed with the IRS by Feb. 28, 2019 if filing by paper and April 1, 2019 if filing electronically. The Forms 1095-B and 1095-C must be distributed to applicable employees by Jan. 31, 2019. The penalties for failure to comply have increased from $260 to $270 per failure. This means that an employer who fails to file a completed form with the IRS and distribute a form to an employee/individual would be at risk for a $540 penalty.

We’ll keep you updated of any developments, including release of the finalized forms and instructions.

2018 Forms 1094-B and 1095-B Draft Instructions »
2018 Forms 1094-C and 1095-C Draft Instructions »

Source: NFP BenefitsPartners

Filed under: Abentras Blog

Federal District Court Dismisses State Law Claims Due to ERISA Preemption

On May 18, 2018, the United States District Court for the Northern District of California granted an insurer’s motion to dismiss state law claims in Stolebarger v. The Prudential Insurance Company of America, 2018 WL 2287672 (N.D. Cal. 2018). As background, Stolebarger brought this case after Prudential denied his claims for long-term disability (LTD), which he was claiming due to suffering from mental illness. His LTD policy was provided through his employment with the Bryan Cave law firm. In bringing this case, Stolebarger claimed that Prudential had violated portions of California’s Unfair Competition Law (UCL), amongst other claims of breach of contract. In the alternative, Stolebarger asserted that they violated ERISA.

Filed under: Abentras Blog