HEALTH CARE REFORM
Below are summaries of some of the industry's latest regulations. For more details, follow the links below.
Effective 1/1/22
Electronic Provider Database
Must provide access to PPO network provider database on plan’s website.
*Note: Electronic provider information is now available through networks directly. Links to available PPO networks are located on our website HERE. PPO networks are responsible for the accuracy and maintenance of their databases and directories.
ID Card Updates
Must provide clear information on deductibles and out-of-pocket limits, along with a telephone number and website address for consumer assistance on ID cards.
*Note: Members of health benefit plans administered by E.D.I.S., will receive an updated ID card showing the out-of-pocket maximum at the start of their new plan year beginning on or after 1/1/22. Click here to access and login to our benefit portal for a PDF copy of your ID Card.
Independent Dispute Resolution
* Note, court challenges in March 2022 are changing provisions of this mandate
A federal process has been established to resolve disputes regarding plan out-of-network payments for emergency services provided by nonparticipating providers/facilities/air ambulances and for non-emergency services furnished by certain nonparticipating providers/facilities at participating healthcare facilities.
Process deadlines available here.
Non-Emergency Care Utilizing OON Provider
Must be revised with language to meet requirements.
* Note: Members of a health benefit plan administered by E.D.I.S., will receive an updated SPD/Plan Document at the start of their new plan year beginning on or after 1/1/22. Click here to access and login to our benefit portal for a PDF copy of your Plan Document.
Prohibition of Balance Billing
Prohibition of Prior Auth for Emergency Care
Prohibition of Surprise Air Ambulance Bill
Prohibition of Surprise Air Ambulance Bill
E.D.I.S. understands the need to make sure our clients are protected should they be subject to a Department of Labor (DOL) audit.
For current E.D.I.S. clients, we automatically provide the following for no additional fee upon implementation, and at renewal:
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Administrative Service Agreement (ASA)
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Plan Document
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Summary Plan Description (SPD)
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Summary of Benefits & Coverage (SBC)
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Schedule of Benefits (SOB)
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Plan Policies and/or Certificates where applicable
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PCORI Counts
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5500 Information
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Employer Mandate reporting information
The above contain the DOL required notices and amendments, and are regularly reviewed by our ERISA attorneys for compliance.
We provide assistance to any client who is undergoing a DOL audit. They give you little notice and require a lot of information. If you let us know as soon as you receive your notice of audit, we will start pulling your documents together and will get them to you within days.
We also offer our ERISA document services to clients who do not utilize E.D.I.S. for its administration services.
For rates and more information, please call (888) 886-7973, or email compliance@employerdriven.com.
PRIVACY CONCERNS?
2021-2022 REGULATIONS
EMPLOYER REPORTING
Information will be added and updated as reporting is due
OUR COMPLIANCE SERVICE
October 14, 2022 - Medicare Part D, Notice of Creditable Coverage
Employers who provide prescription coverage to Medicare Part D eligible individuals must notify these individuals whether the drug coverage they have is creditable or non-creditable. This notice must be provided prior to October 15th of each year. To pull the model notices direct from CMS, you may click here.
Otherwise, you will find a reference chart and fill-able notices below.
July 31, 2022 - PCORI Fee Filing and Payment
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Employers sponsoring a Fully Insured Plan with an HRA/MERP must pay the fee per enrolled employee for any plan that ended in the year 2021.
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Employers sponsoring a self-funded EDHP™, MVP or MEC Plan must pay the fee per enrolled member for any plan that ended in the year 2021.
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The fee is $2.66 per member or enrolled employee for plans ending before October 1, 2021.
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The fee is $2.79 per member or enrolled employee for plans ending on or after October 1, 2021 and before October 1, 2022.
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Additional information about this reporting: CLICK HERE
February 28, 2023 - Employer Mandate Reporting 1094-C, 1095-C
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IRS Transmittal Form 1094-C and all unique 1095-C statements must be postmarked February 28, 2023 and mailed to the Internal Revenue Service
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1095-C Statement to full-time employees is due by March 2, 2023
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Additional Information about this reporting: CLICK HERE
REFORM TIMELINE BY YEAR
Select Any Year Below For More Information
2014 - Key Provisions In Place
2017 - Ongoing Federal Requirements
2018 - No Added Provisions or Changes
If you are concerned that there is a breach of private health information (PHI) or if you suspect a violation of HIPAA laws related to the administration of your E.D.I.S. plan, please contact us by emailing compliance@employerdriven.com.
You may contact us anonymously by phone by first dialing *67 then 888-886-7973. Request to speak to our Compliance Officer.
DON'T FALL PREY TO A SCAM
The American Bankers Association and FDIC report that check fraud is one of the most common methods used today for scammers to take your money. As a company who issues hundreds of thousands of checks to providers, facilities, members and employers, it is easy for scammers to duplicate one of our checks and try to present it as their own.
Employer Driven Insurance Services, Inc. (E.D.I.S.) utilizes security measures such as positive pay to help catch and prevent fraudulent checks from making it through our bank. However, this means that if you receive a fake or counterfeit check which appears to be from E.D.I.S. and you cash or deposit the check CLICK HERE TO READ MORE