Medical Plans

Health Insurance & The COVID-19 Vaccines

As we step closer to the availability of the vaccine to the general population, employer groups will be considering many variables for their employees, including the availability of the vaccine, how their workforce fits into the phased rollout, vaccine costs, and what can be done now to prepare. In an effort to help local organization navigate these topics within the framework of their employer-sponsored medical plans, the Capstone Benefits Team has consolidated the most recent guidance being provided by the largest health insurers in our area:

Independence Blue Cross:

IBX does not specifically address how the plans will cover vaccinations, however the federal government has committed to providing the vaccine itself to the American public at no cost)

Click to Read More: IBX COVID Vaccine Update

Aetna:

  • Aetna will cover the cost of COVID-19 vaccines and their administration without cost sharing for Aetna members in all plans. Our coverage aligns with requirements in the CARES Act and the recent federal regulation. The requirement also applies to self-insured plans.

  • COVID-19 vaccinations will be available at pharmacies, including CVS, as well as doctors’ offices at other clinical sites of care. HHS recently announced a federal government partnership with large pharmacy chains and community pharmacies to access and administer COVID-19 vaccines as they become available.

Click to Read More: Aetna Vaccine FAQs

Cigna:

  • Will the vaccine be considered a preventive service waiving cost share for an employer’s workforce?

    • Any vaccine that receives FDA approval and is recommended by CDC (in partnership with guidance from ACIP), will be covered as a preventive service.

  • Will my health plan with Cigna cover the cost of a COVID-19 vaccine?

    • The vaccine will be covered as a preventive service. Initially, the cost of the vaccine serum will be paid by the government. We expect that providers’ charges for administering the vaccine will be paid under your Cigna medical plan, the same as any other immunization administration charge. We also expect that members enrolled in plans that cover preventive services at 100% will incur no additional cost.

 Click to Read More: Cigna - Understanding COVID19 Vaccines

United Healthcare:

  • When COVID-19 vaccines are authorized by the FDA, members will have $0 cost-share (copayment, coinsurance or deductible), no matter where they get a vaccine, including when two doses are required, as outlined below:

  • Employer and Individual health plans: Members will have $0 cost-share at both in- and out-of-network providers through the national public health emergency period. This applies to fully insured and self-funded commercial health plans.

Click to Read More: UHC Preparing for COVID-10 Vaccine Authorization

For more information or company-specific questions, please contact Sr. VP of Benefits, Joseph Fox:

Email: jtfox@capstoneinsgroup.com

2019 PCOR Fee Filing Reminder for Self-Insured Plans

The PCOR fee filing deadline is July 31, 2019 for all self-funded medical plans and HRAs for plan years ending in 2018.

Please note, this is the final filing and payment for some plans. Plans ending in January through September of 2019 will have one more filing on July 31, 2020. We will send a reminder next year for the final filing and payment.

The plan years and associated amounts are as follows:

(Plan Year; Amount of PCOR Fee; Payment and Filing Date):

  •  February 1, 2017 – January 31, 2018; $2.39/covered life/year; July 31, 2019

  • March 1, 2017 – February 29, 2018; $2.39/covered life/year; July 31, 2019

  • April 1, 2017 – March 31, 2018; $2.39/covered life/year; July 31, 2019

  • May 1, 2017 – April 30, 2018; $2.39/covered life/year; July 31, 2019

  • June 1, 2017 – May 31, 2018; $2.39/covered life/year; July 31, 2019

  • July 1, 2017 – June 30, 2018; $2.39/covered life/year; July 31, 2019

  • August 1, 2017 – July 31, 2018; $2.39/covered life/year; July 31, 2019

  • September 1, 2017 – August 31, 2018; $2.39/covered life/year; July 31, 2019

  • October 1, 2017 – September 30, 2018; $2.39/covered life/year; July 31, 2019

  • November 1, 2017 – October 31, 2018*; $2.45/covered life/year; July 31, 2019

  • December 1, 2017 – November 30, 2018*; $2.45/covered life/year; July 31, 2019

  • January 1, 2018 – December 31, 2018*; $2.45/covered life/year; July 31, 2019

* Final Due Date/Payment for these Plan Years

For the Form 720 and Instructions, visit: https://www.irs.gov/ forms-pubs/about-form-720

The information is reported in Part II.

Please note that Form 720 is a tax form (not an informational return form such as Form 5500). As such, the employer or an accountant would need to prepare it. Parties other than the plan sponsor, such as third-party administrators, cannot report or pay the fee.

Short Plan Years

The IRS issued FAQs that address how the PCOR fee works with a self-insured health plan on a short plan year.

Does the PCOR fee apply to an applicable self- insured health plan that has a short plan year?

Yes, the PCOR fee applies to a short plan year of an applicable self-insured health plan. A short plan year is a plan year that spans fewer than 12 months and may occur for a number of reasons. For example, a newly established applicable self-insured health plan that operates using a calendar year has a short plan year as its first year if it was established and began operating beginning on a day other than Jan. 1. Similarly, a plan that operates with a fiscal plan year experiences a short plan year when its plan year is changed to a calendar year plan year.

What is the PCOR fee for the short plan year?

The PCOR fee for the short plan year of an applicable self- insured health plan is equal to the average number of lives covered during that plan year multiplied by the applicable dollar amount for that plan year.

Thus, for example, the PCOR fee for an applicable self- insured health plan that has a short plan year that starts on April 1, 2018, and ends on Dec. 31, 2018, is equal to the average number of lives covered for April through Dec. 31, 2018, multiplied by $2.45 (the applicable dollar amount for plan years ending on or after Oct. 1, 2018, but before Oct. 1, 2019).

See FAQ 12 & 13, https://www.irs.gov/affordable-care-act/ patient-centered-outcomes-research-trust-fund-fee-questions- and-answers

* This document is designed to highlight various employee benefit matters of general interest to our readers. It is not intended to interpret laws or regulations, or to address specific client situations. You should not act or rely on any information contained herein without seeking the advice of an attorney or tax professional. ©2019 Emerson Reid, LLC. All Rights Reserved. CA Insurance License #0C94240. *