We have important information regarding Massachusetts payor surcharges and the MA Managed Care Organization Payor Assessment Notice. The Commonwealth of Massachusetts, in accordance with statutory changes that were included in its fiscal year 2025 budget, terminated the Health Safety Net surcharge program for payments to acute hospitals and ambulatory surgical centers on January 1, 2025. [...]
A plan management best practice is to collect and store employee waivers when an employee chooses not to enroll on the group health plan, even if the insurer or TPA does not require employers to submit them. These waivers serve as documentation of the employer’s offer of coverage and the employee’s decision to decline it. [...]
In Notice 2023-70, the IRS announced that for plans that end on or after October 1, 2023, and before October 1, 2024, the PCOR rate per covered individual is $3.22 per plan participant. The PCOR fee is calculated based on the average number of lives covered under the policy or plan. As a reminder, the IRS announced [...]
On June 24, 2022, the Supreme Court issued its much-anticipated decision in Dobbs v. Jackson Women’s Health Organization, which stated that there is not a constitutionally protected right to terminate a pregnancy. Employers are now faced with the task of determining how this decision will impact their workforce and their benefit offerings. Self-Insured Plans — as a self-insured [...]
In earlier communications from Diversified Group, you were notified of the requirements of the Transparency in Coverage (TiC) Rules that will be enforced beginning on July 1, 2022. The rules require plan sponsors to create two files — one to disclose in-network provider rates for covered items and services and another to disclose out-of-network allowed amounts [...]
In earlier communications from Diversified Group, you were notified of the requirements of the Transparency in Coverage (TiC) Rules that will be enforced beginning on July 1, 2022. The rules require plan sponsors to create two files — one to disclose in-network provider rates for covered items and services and another to disclose out-of-network allowed amounts [...]
PCOR fees are reported and paid annually using IRS Form 720 (Quarterly Federal Excise Tax Return). These fees are due each year by July 31 of the year following the last day of the plan year. This means that for plan years ending in 2021, the PCOR fees are due by July 31, 2022. For self-funded [...]
IMPORTANT INFORMATION below regarding your obligation to provide a Machine-Readable File by July 1, 2022. Please read and respond accordingly. To meet the requirements of the Transparency in Coverage (TiC) Rules that will be enforced starting on July 1, 2022, plan sponsors must create two files — one to disclose in-network provider rates for covered items [...]
The IRS announced in Notice 2020-84 that the adjusted applicable amount for the Patient-Centered Outcomes Research Institute (PCOR) fee for policy or plan years ending on or after October 1, 2020 and before October 1, 2021 will be $2.66 per plan participant. In Notice 2021-04, the IRS published that the applicable amount for PCOR fees [...]
This checklist is designed to help companies review the key reporting and notice requirements that may apply to their employer-sponsored group health plans under ERISA (the Employee Retirement Income Security Act). Please note that this list is for general reference purposes only and is not all-inclusive. Click to download entire checklist.
