In this episode, with mental health trending as a national discussion, Chase Cannon and Suzanne Spradley discuss mental health parity in health insurance coverage. As background, the federal Mental Health Parity and Addiction Equity Act (MHPAEA) requires that the financial requirements and treatment limitations imposed on mental health and substance abuse disorder benefits be no more restrictive than the predominant financial requirements and treatment limitations that apply to substantially all medical and surgical benefits. Chase quizzes Suzanne on some details relating to quantitative treatment limits (dollar and limit visits) and non-quantitative treatment limits (pre-authorization, reimbursement rates, cost sharing, etc.), including some examples outlined in recent federal guidance on MHPAEA. Suzanne outlines several examples of NQTL treatment limits. The two then discuss two recent cases involving mental health coverage issues, one of which ends in favor of the plan and one of which ends in favor of a participant.
Every other week, NFP's legal experts make the subject of compliance personal for a wide audience. By breaking down the daunting details of emerging policies and bridging the gap between legislation and what it means for the listener, Chase Cannon and Suzanne Spradley make compliance issues relatable and relevant. Visit our Visit our Soundcloud page every two weeks for the most up-to-date episode.
Applicable plan sponsors must file Form 5500-series returns on the last day of the seventh month after their plan year ends. As a result, calendar-year plans generally must file by July 31 of this year (reporting on the 2017 plan year). Plans may request a two-and-a-half-month extension to file by submitting Form 5558, “Application for Extension of Time to File Certain Employee Plan Returns,” by that plan's original due date.
As a reminder, group health plans sponsored by a governmental or church entity aren’t required to file a Form 5500, as those plans aren’t subject to ERISA. Additionally, unfunded, insured or combination unfunded and insured health plans with fewer than 100 participants on the first day of the plan year are also exempt from the filing.
NFP has vendors available to assist with filings. Ask your advisor if you need assistance.
Forms and Instructions »
Form 5500 EFAST2 »
Form 5558, Extension of Time »
The ACA imposed the PCOR fee on health plans to support clinical effectiveness research. The PCOR fee applies to plan years ending on or after Oct. 1, 2012, and before Oct. 1, 2019. The PCOR fee is generally due by July 31 of the calendar year following the close of the plan year.
PCOR fees are required to be reported annually on Form 720, “Quarterly Federal Excise Tax Return,” for the second quarter of the calendar year. Plan sponsors that are subject to PCOR fees but not other types of excise taxes should file Form 720 only for the second quarter. No filings are needed for the other quarters for such employers.
The PCOR fee is generally assessed based on the number of employees, spouses and dependents that are covered by the plan. For plan years ending in 2017 on or before Oct. 1, 2017, the fee is $2.26 multiplied by the average number of lives covered under the plan. For plan years ending between Oct. 1, 2017, and Oct. 1, 2018, the fee increases to $2.39. Form 720 and corresponding instructions were revised to reflect the increased fee.
The PCOR fee can be paid electronically or mailed to the IRS with the Form 720 using a Form 720-V payment voucher. According to the IRS, the fee is tax-deductible as a business expense.
As a reminder, the insurer is responsible for filing and paying the fee for a fully insured plan. The employer plan sponsor is responsible for filing on a self-insured plan, including an HRA. A stand-alone dental or vision HRA would be excepted and wouldn’t be subject to the PCOR fee.
Form 720 »
Form 720 Instructions »