Health care plans must begin filing information on health plan participants and beneficiaries who are eligible or potentially eligible for Medicare coverage. The filing is made with the Centers for Medicare and Medicaid Services (CMS). These reports must begin in April 2009 for most plans and January 1, 2009 for plans that are currently sharing information with Medicare using a Voluntary Data Sharing Agreement (VDSA).
For insured plans, the insurance company will be responsible for the report. For self-insured plans, in most cases, the third party administrator (TPA) must file the report. Medical flexible spending (Section 125) accounts are exempt from the requirement. Stand-alone dental and vision plans are also exempt. Employers will be responsible for reporting information on health reimbursement accounts (HRAs) or other limited medical reimbursement programs where the reimbursements are administered and paid by the employer, and not managed by an outside third party administrator. Each employer must determine whether it has one or more of these self-administered, self-insured health care plans and respond accordingly.
The purpose of this reporting is to assist CMS with enforcement of the Medicare secondary payer (MSP) rules. These rules impose primary health care coverage obligations on an employer’s plan for any employee or dependent of an active employee where Medicare coverage is also available. Failure to file the reports will result in civil monetary penalties for each day of delay, in addition to any other penalties that might result from inappropriate shifting of primary coverage to Medicare.
Filing is done electronically. Further guidance is available on the CMS website at www.cms.hhs.gov. Plan administrators must list employees who meet certain age criteria and must supply Social Security numbers for their family members. Even if a TPA or insurance company is responsible for filing this report, many employers will be asked to supply supporting data to assist the other party in completing the report.
If your plan provides reimbursement for any medical expenses, is not exempt as a medical expense reimbursement plan and is not administered by an outside third party administrator, we recommend you promptly examine the CMS website noted above. If you have any questions about your reporting obligations, consult a member of the Employee Benefit Practice Team.