2023 Upcoming Fall and Winter Compliance Deadlines

Summary Annual Report (SAR): A summary annual report (SAR) is a boiled-down summary of the Form 5500. A SAR is required for any plan subject to Form 5500 filing, except for self-insured plans without any segregation of assets in a trust or otherwise (unfunded).

• Calendar Year Plans - September 30 deadline applies to ERISA plans that filed Form 5500 on or before July 31, 2023.

Non-calendar year plans - the SAR deadline is nine months after close of the plan year or two months after the plan’s extended 5500 deadline.

Medicare Part D Notices: Employers offering prescription drug coverage must issue the Notice of Creditable Coverage to individuals by October 14. Model Notice letters are available on the CMS website.

Note: Employers may provide the notice any time during the 12 months preceding October 14. For more information, review our Reminder – Medicare Pat D Creditable Coverage Notice and Reporting Requirements.

Special Open Enrollment Period for Small Groups: The ACA requires carriers to offer a one-month special open enrollment period (SEP) each year from November 15 to December 15 for a January 2024 effective date. The SEP is for groups that don’t have to meet contribution or participation requirements as long as they meet all other standard rules.

MLR Rebate Distribution: ERISA plan sponsors who received a Medical Loss Ratio (MLR) rebate on September 30th must pay the appropriate rebate amount to participants. If a plan sponsor paid the entire cost of the insurance, the employer could retain the entire rebate.

The most common situation is when the plan sponsor and participants contribute toward the cost of coverage. In this case, the plan sponsor must determine the portions of the total plan cost contributed by both parties so the MLR rebate can be allocated among participants, plan costs, and the employer.

Plan sponsors must first determine total participant contributions for the year used to calculate the MLR rebate. Current rebates are based on premiums paid to the carrier for the calendar year 2022. For more information on this click here.

For Carrier specific rebate information review the carrier results for 2022. As we continue to receive information from the carriers this information will be updated. 

Gag Clause Attestation – The very first attestation must be submitted by December 31, 2023. The first attestation applies to the period from December 27, 2020 through the date the attestation is made.

For fully insured plans, most of the carriers will be providing this information to CMS.

Self-funded/Level funded plans should contact their carrier or TPA to find out if they will be submitting the information on behalf of the group health plan.

For more information click here.  Carrier specific information is also published on our website as the carriers inform us of their approach to this requirement. 

Notice of Patient Protections – This notice is a result of the No Surprise Billing Act that went into effect on January 1, 2022. This notice is to explain to an individual under certain circumstance there can be No Balance Billing for Emergency Services, even if the services are provided out-of-network.

Sample Disclosure Notice

CHIP Notice – this annual notice is required by employers that maintain group health plans in states that provide premium assistance subsidies under a Medicaid plan or a Children’s Health Insurance Plan (CHIP).  Review our article regarding this requirement.

Model notice

Employers sponsoring prescription drug plans must report to CMS within 60 days after the beginning of the plan year regardless of whether the coverage is creditable.

• For plan years beginning September 1, 2023 – due October 31, 2023
• For plan years beginning October 1, 2023 – due November 30, 2023
• For plan years beginning November 1, 2023 – due January 2, 2024 (Dec 31st is a Sunday and January 1 is a federal holiday)
• For plan years beginning December 1, 2022 – due January 30, 2023

For more information review CMS.gov Disclosure to CMS Form.