Prior to enrolling in the COSE MEWA, all employers must read and agree to the administration and compliance guidelines. Employers are also required to provide a Summary of Benefits and Coverage (SBC). Please see the below links for detailed information on employer requirements, plan SBCs, Underwriting Guidelines and more.
Annual Notice: Benefits Reminders
The Annual Notice of Health Benefits reminders will be mailed every year, during the first quarter, to all employers enrolled in the COSE MEWA. It is the employer’s responsibility to distribute this information to their employees.
Administration and Compliance Guide
This guide contains information on administering your plan and provides summary guidance with applicable state and federal laws.
These guidelines summarize your group’s requirements for participating in the MEWA. Refer to this document for help with setting up funding rate contributions, determining residency and enrollment requirements, and more.
Transparency in Coverage
The Transparency in Coverage mandate requires insurers and group health plans to make rate information publicly accessible to members and non-members starting in July of 2022. As a self-insured group and to be considered compliant with the mandate, the regulations specify that you must include a link on your own website that directs users to the location of the publicly available machine-readable files (MRFS).
Transparency in Coverage Rule Requires Rate Information to Post Starting July 2022
Insurers and group health plans are required under the Transparency in Coverage rule to make rate information available for both members and non-members. Medical Mutual will post this information starting July 2022:
- Negotiated rates for in-network providers.
- Allowed amounts and historical billed charges for out-of-network providers.
Per the mandate, the information must be:
- Provided in a CMS-approved format.
- Updated monthly.
- Hosted publicly (not behind log in).
How We’ll Execute This Requirement
- Medical Mutual will share rate information in a machine-readable file (MRF) format for Medical Mutual contracted providers.
- The information will be posted to a dedicated MRF landing page accessible from MedMutual.com starting July 2022.
Please see the link below which you can post on your website or this will be updated with content and point your employees to landing page of all our machine readable files once they are made available come July 1st.
Summary of Plan Description
The summary plan description (SPD) describes benefits and terms of coverage. Medical Mutual will create a generic SPD by wrapping the Plan Document with the Benefit Book for each employee. However, employers are responsible for creating and distributing group-specific plan documents and the SPD. To help you create a group-specific SPD, the COSE MEWA offers a template.
Summary Plan Description Help
Summary of Benefits and Coverage
Health insurers are required by the Affordable Care Act to provide a Medical Summary of Benefits and Coverage (SBC). An SBC helps you better understand your health plan by using a standard format that helps you easily compare plans.
Premium Only Plan
A Section 125 Premium-Only-Plan (POP) is a cafeteria plan that lets employees pay their health insurance premiums using tax-free dollars. Traditionally, POP plans have been used in combination with employer-sponsored group health insurance.
Medicare Part D Creditable Coverage
Employer groups are required by law to send an annual notification to members who are currently or will become Medicare eligible during 2021 regarding their prescription drug plan's creditable (at least as good as the base Medicare Part D plan design) status related to Medicare Part D coverage.
We will also send a letter to group officials of each plan with a Medicare-eligible employee, dependent or retiree to whom we mailed a creditable coverage notice. The letter reminds the group official of his or her responsibility to provide notices to eligible employees and dependents at all other times required by law.
All employers, regardless of funding type or group size, must complete the Disclosure to CMS Form on the Centers for Medicare and Medicaid Services (CMS) website at https://www.cms.gov/CreditableCoverage/ to notify the government of their health plan's creditable status.
The COSE MEWA offers a variety of plans to participating employers and their employees. Most of these plans are creditable, regardless if the participant is Medicare Primary or Medicare Secondary, except for the plans mentioned below:
For the HSA 4000 MMRx, HSA 5000 PD Rx and the HSA 6550 w/MMRx:
If Medicare pays primary to group coverage, then these plans are NOT creditable.
If Medicare pays secondary to group coverage, then these plans are creditable.
If you have any questions about the creditable coverage notice or your responsibility to provide it to your Medicare-eligible participants and dependents, please contact your Medical Mutual representative or broker.