Smart Benefits: Deadline Next Week for Health Plan Identifiers
Monday, October 27, 2014
By November 5, large health plans must obtain a unique national health plan identifier number (HPID), which will be required in certain transactions subject to HIPAA by November 7, 2016.
Large plans are considered those with more than $5 million in annual receipts. Since health plans don’t have receipts, the Department of Health and Human Services says insured plans should look at premiums for the prior plan year and self-funded plans should look at claims paid for the prior plan year.
Small health plans with less than $5 million in claims during the prior plan year have until November 5, 2015, to obtain an HPID.
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Health savings accounts (HSAs) and health flexible spending accounts (FSAs) do not require an HPID because they are individual accounts directed by the consumer to pay health care costs. HRAs may require an HPID if they meet the definition of health plan. HRAs that cover deductibles only or out-of-pocket costs do not require HPIDs as these are more like additional plan benefits than stand-alone plans.
HPIDs are also not required for other benefits that are not considered a group health plan, such as life, disability, or a health savings account (although the related high deductible health plan will need an HPID).
Who Obtains the Number?
The insurer carrier obtains the identifier number for fully insured plans. Self-funded plans, on the other hand, need to obtain the number, even if they use a third party administrator (TPA) to pay claims.
How do employers get an HPID?
An employer can apply for its HPID through the Centers for Medicare and Medicaid Services (CMS) website. Many employers will first need to create an account in the CMS Enterprise Portal to obtain a user ID and password.
Amy Gallagher has over 21 years of healthcare industry experience guiding employers and employees. As Vice President at Cornerstone Group, she advises large employers on all aspects of healthcare reform, benefit solutions, cost-containment strategies and results-driven wellness programs. Amy speaks regularly on a variety of healthcare-related topics, and is often quoted by national publications on the subject matter. Locally, Amy is a member of SHRM-RI, the Rhode Island Business Group on Health, and the Rhode Island Business Healthcare Advisory Council.
Related Slideshow: New England’s Healthiest States 2013
The United Health Foundation recently released its 2013 annual reoprt: America's Health Rankings, which provides a comparative state by state analysis of several health measures to provide a comprehensive perspective of our nation's health issues. See how the New England states rank in the slides below.
Definitions
All Outcomes Rank: Outcomes represent what has already occurred, either through death, disease or missed days due to illness. In America's Health Rankings, outcomes include prevalence of diabetes, number of poor mental or physical health days in last 30 days, health disparity, infant mortality rate, cardiovascular death rate, cancer death rate and premature death. Outcomes account for 25% of the final ranking.
Determinants Rank: Determinants represent those actions that can affect the future health of the population. For clarity, determinants are divided into four groups: Behaviors, Community and Environment, Public and Health Policies, and Clinical Care. These four groups of measures influence the health outcomes of the population in a state, and improving these inputs will improve outcomes over time. Most measures are actually a combination of activities in all four groups.
Diabetes Rank: Based on percent of adults who responded yes to the question "Have you ever been told by a doctor that you have diabetes?" Does not include pre-diabetes or diabetes during pregnancy.
Smoking Rank: Based on percentage of adults who are current smokers (self-report smoking at least 100 cigarettes in their lifetime and currently smoke).
Obesity Rank: Based on percentage of adults who are obese, with a body mass index (BMI) of 30.0 or higher.
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