Compliance Resources
Prior to enrolling in the COSE Benefit Plan, 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.
Premium Split Reporting Survey
A flyer regarding the Premium Split Reporting Survey will be included in renewal exhibits beginning with 1/1/24 renewals. Completion of this survey is a requirement of the Section 204 Consolidated Appropriations Act (CAA). The flyer in the renewal exhibits includes a QR code for easy access of the survey. This survey should be completed by all groups, and we appreciate your participation and support with this initiative.
A sample survey is included below for your reference. If you need a new copy, please refer to your renewal packet. If you need a new copy of your renewal you can request one by contacting your broker or Medical Mutual Representative.
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 Benefit Plan. It is the employer’s responsibility to distribute this information and the accompanying Benefit Reminders flyer to their employees.
Administration and Compliance Guide
The Administration and Compliance Guide contains information on administering your plan and provides summary guidance with applicable state and federal laws.
Underwriting Guidelines
Our Underwriting 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 began posting 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 Execute This Requirement
Medical Mutual shares rate information in a machine-readable file (MRF) format for Medical Mutual contracted providers.
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.