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Healthcare Reform

Agents and Brokers: Be prepared for Plan Year 2016 by Registering Today for Upcoming Open Enrollment Webinars
Beginning in November, 2015, and continuing through the end of the Open Enrollment period, CMS will be hosting weekly webinars for agents and brokers. These webinars will provide agents and brokers with updates and announcements related to Open Enrollment, as well as reminders of upcoming critical deadlines. The webinars will also provide highlights of relevant program content or information. All sessions are open to all agents and brokers as long as space is available, so register today!



Click here to download the full pdf document

HorizonBlue-Logo-Updated-Jan15 2013




October 27, 2015 - Applies to: All markets - New Fees Mandated Under ACA: The Basics
The Affordable Care Act (ACA) continues to change the health care landscape. In addition to new IRS reporting requirements covered in our October 13, 2015 Brief Notes, there are also new fee payment requirements that both self-insured and fully insured groups need to familiarize themselves with. Horizon Blue Cross Blue Shield of New Jersey wants to help you keep your clients aware of these mandates, to help ensure that the fee payments are handled correctly and on time.



Click here to download the full pdf document


IRS coverage reporting forms are now available  
The IRS finalized its coverage reporting forms for calendar year 2015, for groups with 50 or more full-time employees (including full-time equivalent employees). The forms are written to comply with the regulations the IRS described in Notice 2015-68 and other guidance set forth in that notice.
Employers subject to section 4980H of the Internal Revenue Code, generally meaning employers with 50 or more full-time employees (including full-time equivalent employees) in the preceding calendar year, should use the following forms to report the information required under Code sections 6055 and 6056 about offers of health coverage and enrollment in health coverage for their employees.

Form 1094-C  
Form 1094-C must be used to report to the IRS summary information for each employer and to transmit Forms 1095-C to the IRS.

Form 1095-C
Form 1095-C is used to report information about each employee. An "Applicable Large Employer" (ALE) member must file Form 1095-C for each employee who was a full-time employee of the ALE member for any month of the calendar year.
For more information, read the IRS instructions for these forms.

Registration is Now Open: Reinsurance Contributions Supporting Documentation

The 2015 ACA Transitional Reinsurance Program Annual Enrollment and Contributions Sumission form is NOW AVAILABLE. All contributing entities must submit the 2015 Form and schedule reinsurance contribution payment(s) no later than Monday, November 16, 2015. Click below for the deadline list.

Key Reinsurance Contribution Dates and Deadlines for the 2015 Benefit Year

Self-Insured Plan – The plan itself is responsible for the reinsurance contributions but may elect to use a TPA or ASO contractor to transfer the reinsurance contributions.

Fully Insured Plan – The issuer is responsible for the reinsurance contributions. In a state-operated program, the state may collect fully insured market contributions within its state or request that HHS do so on its behalf. When HHS is operating the program on behalf of a state, HHS will collect the contributions from the fully insured market. Click below for information website and corresponding forms.


Deadline Reminder

Medicare-eligible policyholders must be notified of whether their prescription drug coverage is creditable coverage — meaning the coverage is expected to pay on average as much as the standard Medicare prescription drug coverage — before October 15th.

The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) requires all employer-sponsored health plans with prescription drug coverage to provide a Part D notice to each covered person who is, or who is about to become, eligible for Medicare.  A Disclosure Notice advises as to whether or not the plan’s prescription drug coverage is at least as good as the prescription drug coverage under the Part D program.

The purpose of the Disclosure Notice is to enable a plan participant to make an informed decision about enrolling in Part D prior to initial eligibility for Medicare, and enables Medicare eligible individuals to decide to replace their current coverage with Part D.  

An updated Disclosure Notice must be provided prior to the Part D annual enrollment period of October 15th , annually, may be provided with other plan information materials (such as enrollment materials) and at other prescribed times (including upon request, and prior to a an individual’s initial enrollment period for Part D, or whenever prescription drug coverage ends) but need not be sent as a separate mailing.  

Note:  The October 15 “participant” notice requirement is different from the annual plan sponsor obligation to tell CMS whether the plan is providing “creditable coverage” or not.  Information about electronic notification to the government (disclosure to CMS) can be found by clicking on the following LINK