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HEALTH CARE REFORM 

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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.

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For current E.D.I.S. clients, we automatically provide the following for no additional fee upon implementation, and at renewal:

  • Administrative Service Agreement (ASA)

  • Plan Document

  • Summary Plan Description (SPD)

  • Summary of Benefits & Coverage (SBC)

  • Schedule of Benefits (SOB)

  • Plan Policies and/or Certificates where applicable

  • PCORI Counts

  • 5500 Information

  • Employer Mandate reporting information

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The above contain the DOL required notices and amendments, and are regularly reviewed by our ERISA attorneys for compliance.

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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.  

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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?
EMPLOYER REPORTING
Information will be added and updated as reporting is due

OUR COMPLIANCE SERVICE

 

March 1, 2024  - Employer Mandate Reporting 1094-C, 1095-C

 

 

July 31, 2024  - PCORI Fee Filing and Payment

  • 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 2022.

  • 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 2022.

  • The fee is $2.79 per member or enrolled employee for plans ending before October 1, 2022.

  • The fee is $3.00 per member or enrolled employee for plans ending on or after October 1, 2022 and before October 1, 2023.

  • Additional information about this reporting: CLICK HERE

  • DOWNLOAD IRS FORM 720

  • DOWNLOAD IRS INSTRUCTIONS

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October 14th Annually - 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. 

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Otherwise, you will find a reference chart and fill-able notices below.

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CAA Section 204 Prescription Drug Data Collection (RxDC) Reporting

Insurers offering group or individual coverage must report annual data on drug utilization and spending trends to the federal government.  Fully insured carriers will handle the reporting on behalf of employer groups and individuals which means our HRA and MERP clients do not need to report.  

 

E.D.I.S. will handle the reporting on behalf of our Stop Loss clients ahead of the June 1st deadline each year.

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December 31, annually - Gag Clause Attestation

In late February 2023, the IRS, DOL and HHS issued a joint announcement detailing how group health plans are to comply with the gag clause attestation requirements, or Gag Clause Prohibition Compliance Attestations (GCPCA), established by the Consolidated Appropriations Act, 2021. Employer sponsored group health plans (both self-funded and fully insured) are prohibited from entering into agreements with a health care provider, network or association of providers, Third Party Administrator, or other service provider where the plan is restricted from accessing and sharing certain information. Employer sponsored group health plans (both self-funded and fully insured plan sponsors) are also required to submit an annual attestation that the plan is in compliance with these requirements.

This reporting is due by December 31st each year and applies to both the health insurance issuers (Carriers) and the plan sponsors (Employers).

If you have an employer group with an HRA or MERP through EDIS, you can rest assured that this has been completed for your employer group.

If you have an employer group with an EDHP™ plan, EDIS has submitted for both the carrier and the employer group sponsoring the plan.

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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. 

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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

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