ALERT: Small Group D1 Reporting Requests from Carriers

*ALERT* Small Group D1 Reporting Requests from Carriers – Response Required

We have been getting a lot of questions from our clients with Small Group Medical policies in regards to some data reporting requests they are receiving from the Medical Carriers, so we would like to share with everyone a little more about what is going on, and how to complete the forms you are being sent.

1. What is this about?  As part of the Federal Consolidated Appropriation Act Section 204, health coverage issuers and group plan sponsors are required to submit information about prescription drug and healthcare spending.  This includes reporting premium and life year, or “D1”, data to federal agencies such as the Center for Medicare and Medicaid Services (CMS), and the Department of Health and Human Services (DHS).  The Centers for Medicare and Medicaid Services provide detailed info on the law and its requirements. Click here to view.

2. What do they need?  The Carriers have to do the filing for you- but there are a few details they need from you- thus the form request.  *FYI, if you do not reply to the Carrier and provide them with what they need, you are technically OUT OF COMPLIANCE with the law and required to do the filing yourself.  So please respond to them ASAP.*  They generally need basic info like your group name and number, but they also need to know the average premiums percentage paid by the Employer, total premiums paid by the Employer, and total premiums paid by the Employees. Blue Shield offered a helpful FAQ form. Click here to view the D1 Intake FAQ. United Healthcare also has a great FAQ booklet you can view in .PDF format. Click here to view the booklet.

3. I’m looking at this form and don’t know how to answer all of these questions, what should I do?  Call us.  We’ll help!  The most frequently asked question so far is: How do I answer ‘is this an Administrative Services Only (ASO) group?  The answer is no for all of you.  Our Small Group clients are all Fully Insured clients.  Also, if you have less than 100 employees it is likely you do not file a 5500 report with the IRS so you can answer ‘no’ in regards to any of that.

4. Why are we doing more crazy paperwork filing?  Great question.  We don’t enjoy it either! Our main message here is this: It is in your best interest to respond immediately, as this is a legally required filing now, and the Carrier has to do the bulk of the work on the back end so they are actually helping us here.

Be sure to reach out to your Account Manager or Producer with any questions that arise, or feel free to Contact Us for assistance. We’re happy to help!