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5500 Preparer's Manual for 2012 Plan Years
The premier resource in the field of Form 5500 preparation, 5500 Preparer's Manual will help you handle the required annual Form 5500 filings for both pension benefits and welfare benefit plans.
from Spencer’s Benefits Reports: The Centers for Medicare and Medicare Services (CMS) has announced a proposed rule to establish standards for the Consumer Operated and Oriented Plans (CO-OPs) provided for in the Patient Protection and Affordable Care Act (ACA).
CO-OPs are private, nonprofit health insurers with a board made up of members, designed to offer quality, affordable, consumer-friendly health plans in every state. A CO-OP, much like a health maintenance organization (HMO) or a preferred provider organization (PPO), will offer health insurance options through a health benefit exchange and will be subject to the same rules as other health insurers. The proposed rule is scheduled to be published on July 20.
CO-OPs are designed to give consumers and small businesses control over their own health insurance and must use any profits to benefit the CO-OPs’ members, including to lower premiums, improve health benefits, improve the quality of members’ health care, expand enrollment, and otherwise contribute to the stability of coverage for members, the CMS said.
The proposed rule also provides standards for insurers to qualify for a portion of $3.8 billion available for repayable loans to help start-up and capitalize the new health plans. All CO-OP loans must be repaid with interest and loans will only be made to private, nonprofit entities that demonstrate a high probability of becoming financially viable.
A CO-OP may elect to sell coverage to small businesses, helping give them the control over their health coverage that many of their larger competitors have now. Small business owners will be able to go through a new competitive insurance marketplace for small businesses known as a Small Business Health Option Program or “SHOP.” The proposed rule ensures that a CO-OP that offers any coverage to small businesses also participates in a SHOP.
The CO-OP program contains extensive provisions to protect against fraud, waste, and abuse. CO-OP loan recipients will be subject to strict monitoring, audits, and reporting requirements for the length of the loan repayment period plus ten years. Recipients will submit semiannual program reports and quarterly financial statements. Additionally, the CMS will conduct audits including site visits, as appropriate. CO-OPs must meet a series of milestones as laid out in their loan term agreements before drawing down any money from the program.
Starting Jan. 1, 2014, CO-OPs and all other health insurers will have to meet a set of standards in order to sell health plans through the Exchanges. As an extra protection, CO-OPs also will demonstrate that premiums and any federal loans are being used appropriately and for the benefit of enrollees. In addition, the rule proposes that CO-OPs have a management team with expertise in health insurance, and that the board include individuals with expertise in the business of insurance.
Working from the recommendations of the Federal Advisory Board, public advisory committee, the rules proposing the framework were developed with significant input from many stakeholders, including testimony at public meetings from consumers, small businesses, and health care providers. The CMS is taking public comment on the proposal and expects to release soon a funding opportunity announcement regarding the availability of loans to start up CO-OPs.
Several successful health insurance cooperatives currently exist around the country, covering nearly 2 million individuals. A number of diverse groups are organizing to take advantage of this new opportunity, the CMS explained. In one state, primary care providers are working to create a CO-OP to focus on care for rural areas. In another, a CO-OP steering committee has been formed by interested physicians, business experts, and community groups.
To be considered, comments must be received no later than September 16, electronically at http://www.regulations.gov (follow the “Submit a comment” instructions); or by regular mail at Centers for Medicare and Medicaid Services, Department of Health and Human Services, Attention: CMS-9983-P, P.O. Box 8010, Baltimore, MD 21244-8010. In commenting, please refer to file code CMS-9983-P.
For further information, contact Anne Bollinger at (301) 492-4395, for issues related to eligibility and CO-OP standards; Catherine Demmerle at (301) 492-4156 for issues related to conversions and program integrity; and Meghan Elrington at (301) 492-4388, for general issues and issues related to loan terms.
For more information on this and related topics, consult the CCH Pension Plan Guide, CCH Employee Benefits Management, and Spencer's Benefits Reports.
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