The Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS), require that employers who participate in Employer Sponsored health insurance programs provide information about the size of their workforce.
To comply with regulations and provide accurate information, employers need to complete a questionnaire that will be provided by their respective insurance carrier:
Why is this Data Collection Required?
About CMS Data Collection
Health insurance carriers must collect and report specific employee counts for each participating employer to CMS to satisfy Section 111 of the Medicare, Medicaid and State Children’s Health Insurance Plan Extension Act of 2007 (MMSEA).
The data is used by CMS to determine if Medicare is the primary or secondary payer for your employees and their dependents who are eligible for Medicare. This information is required even if you have no Medicare eligible employees or dependents.
Employers who do not submit this information will automatically have their group size reported to CMS as greater than 20 employees, which will limit or change the plan availability for individuals who are otherwise eligible for a Medicare plan.
About MLR Classification
The ACA requires insurance carriers that offer fully insured health plans to calculate and report their medical loss ratio (MLR) annually to HHS. Insurance Carriers must collect detailed information regarding the total number of employees in a company so that they can determine whether the business is classified as small or large under MLR regulations. This information will also be used by the health insurance carriers to determine whether an employer group is entitled to a premium rebate, if applicable.
Employers who do not submit this information will have the number of employees reported to HHS based off of an insurance carrier's billed employee count. This may not be the same as the total number of employees and may affect the employer's MLR classification, which is used to determine whether your group is eligible for any applicable carrier premium rebate.
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Source: HR 360, Inc.
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