E to E...by Employers for Employers E to E provides information from a business perspective that will educate regional employers about significant healthcare issues to help them make decisions benefiting their organizations and employees.

 Sponsored by Northern Illinois Health Plan

August 2014 Issue


Are You Missing Due Dates?
–Affordable Care Act (ACA) Fees Kick In

Attention! Out-Of-Pocket Limits Must Now Inlcude Co-Payments And Prescription Costs

Healthcare Coverage For Same Sex Couples? Depends On Your Plan And Location

NIHP Introduces Diabetes Management Program

Apps That Earn An "A"

Quick Poll – Review

August Quick Poll – Vote

Contact Information



The latter half of 2014 brings two ACA fees to the forefront as you work to comply with the new laws. Read on to make sure your business is fulfilling its requirements.

PCORI Fees: Many U.S. employers are scheduled to pay their first or second round of Patient-Centered Outcomes Research (PCORI) fees. The Patient Protection and Affordable Care Act (PPACA) requires insurers, sponsors of self-funded plans, and sponsors of health reimbursement arrangements (HRAs) to pay these fees to finance the operations of PCORI.

As we have discussed in recent issues of E to E, PCORI is authorized by Congress to fund and disseminate research that will provide information about the best available evidence to help patients and their healthcare providers make more informed decisions. PCORI’s research is intended to give patients a better understanding of the prevention, treatment, and care options available, and the science that supports those options.

Due Date Summary:

  • July 31, 2013:
    • For plans that ended 10/1/12 – 12/31/12, the fee was $1 per covered life and was due before 7/31/13.
  • July 31, 2014:
    • For plans ending 1/1/13 - 9/30/13, the fee is $1 per covered life and is due before 7/31/14.
    • For plans ending 10/1/13 – 12/31/13, the fee is $2 per covered life and is due before 7/31/14.
  • July 31, 2015:
    • For plans ending 1/1/14 – 9/30/14, the fee is $2 per covered life and is due before 7/31/15.

*For plans ending 10/1/14 – 9/30/19, the applicable dollar amount is further adjusted to reflect inflation in National Health Expenditures, as determined by the Secretary of Health and Human Services.

Transitional Reinsurance Fees: The Transitional Reinsurance Program of the Patient Protection and Affordable Care Act (PPACA) is designed to help stabilize premiums in the individual market in 2014-2016. It is intended to collect fees from group health plans to partially reimburse insurers in the individual Exchange/Market who may disproportionately cover high-cost individuals.

Due Date:

  • January 2015: First installment is due. Costs include:
    • $63 per participant for 2014 ($52.50 per covered life due in January 2015 & $10.50 per covered life due late in the 4th quarter of 2015).
    • $44 per participant for 2015 ($33 per covered life due in January 2016 and $11 per covered life due late in the 4th quarter of 2016).
    • The fee for 2016 has not yet been determined.


Meeting IRS 6055 and 6056 reporting requirements
EBN, June 9, 2014


We now know that out-of-pocket limits for 2015 must include co-payments and prescription costs. With that information in hand, we are working to decipher exactly what that means for each plan and determining efficient tracking processes to keep you and your employees in-the-know and organized. These limits DO NOT apply to grandfathered plans.

To summarize, the limit on out-of-pocket costs for 2014 cannot be more than $6,350 for an individual or $12,700 for a family. (In 2015, these increase to $6,600 for single and remain $12,700 for family.) This limit includes costs for doctors’ services, hospital care, and prescription drugs.

NIHP is working with Prescription Benefit Managers and other HR personnel to get reports and data to help them make informed decisions. Call us at 815-599-7050 if you’d like to discuss your options.


What are PPACA’s 2015 out-of-pocket limits?
HR Focus, June 2014, p. 7

FAQs about the ACA: Out-of-pockets and preventative care
EBN, June 19, 2014


Recent legislation legalizing same-sex marriage is making it possible for more people to say “I do.” It also expands the number of people eligible to utilize insurance coverage.

In states like Illinois that have legalized same-sex marriage, employers with fully insured plans are required to offer equal health plan coverage to same-sex and opposite-sex spouses. However, self-insured ERISA plans are not subject to state insurance law. Thus, employers with self-insured plans may not be required to provide equal coverage to same-sex spouses – but they can likely anticipate a court challenge if they decide not to.

Your best bet? Check your plan’s language. Then call us at NIHP if you have any questions. Most plan documents specify that coverage includes the employee’s “legal spouse” with no restrictions based on gender. If a same-sex partner is not specifically excluded, your plan is likely inclusive.


NIHP has recently introduced our program for Diabetes Disease Management to align with the latest standards in diabetes care. The goal of the program is to improve health outcomes for people with diabetes, and uses a multi-faceted approach to achieve the best possible therapeutic outcomes based on the assessment of members’ needs, ongoing care monitoring, evaluation, and tailored interventions.

The NIHP Diabetes Disease Management Program provides for management of this chronic disease through the use of disease-specific interventions and education to empower members with the self-care management skills necessary to reduce medical complications. The Program utilizes evidence-based guidelines and collaboration with the primary care provider.

Diabetes is associated with an increased risk for a number of serious and sometimes life-threatening complications. Good control of the condition can help reduce these risks and decrease the cost of medical care.

If you have questions about how this program can impact your plan, or would like to know more about how it can benefit your organization, call our in-house experts at 815-599-7050.


When we find something that might make life a little easier for you or your employees, we like to share it. So check out these healthcare-related Apps that range from fitness motivators to weight-loss guides to symptom evaluators. We know many people who have found them helpful, and we hope you will, too.

  • My Fitness Pal: a very popular App built around a user-contributed database of more than 3 million foods that aims to provide helpful weight-loss tools.
  • Withings: designed for anyone who wants to lose a few pounds, exercise more, keep an eye on their blood pressure, or sleep better. The App stores history of your data, and strives to help you understand it and improve it over time.
  • WebMD: offers on-demand healthy living information in addition to physician-reviewed health content and interactive tools.
  • Fooducate: a personal grocery advisor, designed to educate you about the foods you eat using a simple barcode scanner.

Do you have a healthcare-specific App you’d like to recommend to our readers? Let us know!

A Quick Review of Last Issue's "Quick Poll"

In the April 2014 issue of E to E we asked readers, "Is NIHP helping you stay up-to-date on how the Affordable Care Act (ACA) impacts your business?" Specific survey results are noted in the chart, below.

July Quick-Poll Summary

August Quick Poll – Vote

Do you use job-related Apps on a regular basis?
(Click a response to vote. Answers are strictly anonymous.)

Then, visit the NIHP website to view this issue's quick poll results.

For more information contact us at:
(800) 723-0202 or NIHPCustomerService@fhn.org

Northern Illinois Health Plan

773 W. Lincoln Blvd., Suite 402, Freeport, IL 61032

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