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Employer Group Size Reporting

Health Alliance Plan (HAP) strives to help our clients by directing them to information that may be helpful. If you have questions or need assistance determining your employer group size, please refer to the following documentation:

These resources provide Medicare regulations that affect employers and will assist with meeting responsibilities and obligations under the Medicare Secondary Payor (MSP) laws. HAP does not provide legal or human resources advice. If you have further questions, we encourage you to consult with an attorney or human resource professional.

Please fill out the group size form, which can be found below.

Medicare secondary payer (MSP) is the term used by Medicare when Medicare is not responsible for paying first.  MSP regulations for beneficiaries entitled to Medicare due to age or disability require information on employer size to determine the correct primary payer.[1] Employer size is based on the number of employees during specified time periods, not the number of individuals covered under the Group Health Plan.

[1] Employer size is not a factor if the beneficiary is entitled to Medicare due to ESRD.

As your insurer, HAP is required by law to report employer size data to the Centers for Medicare and Medicaid Services (CMS)[2] through Section 111 reporting. This reporting ensures proper coordination of benefit payments and protection of the Medicare Trust.

[2] Federal agency that oversees the Medicare program.

Failing to report the accurate employer group size, or changes in employer size, may result in incorrect primary payment errors.  Per CMS, if there are errors in primary payments, the group health plan (employer) or issuer (HAP) may have to reimburse Medicare.

Employer group size is determined by answering the following questions:

  • Under the MSP provisions, an employee is an individual who works for an employer, on a full or part-time basis, and receives remuneration for their work.  This includes anyone for whom a W-2 form was filed under the Employer Identification Number (EIN)/Federal Tax ID, including intermittent and/or seasonal employees.
    • Subsidiaries of foreign companies must count the number of employees in the organization worldwide.
    • If the employer is part of a multi-employer/multiple employer plan, this field should reflect the size of the largest employer in the plan.
  • Does an employer have less than 20 full-time and/or part-time employees on their “payroll” and are not part of a multi-employer group health plan?
  • Does an employer have 20 or more full-time and/or part-time employees on their “payroll” for each working day in each of 20 or more calendar weeks in the current or preceding calendar year? The 20 weeks do not have to be consecutive.
  • Does an employer have 100 or more full and/or part-time employees during the prior calendar year for 50% or more of the employer’s business days? 

Group size form

* Asterisk indicates required field

Be sure to count total working employees for whom a W-2 form was filed

This information can be found on your HAP invoice. Your Group ID is the 8 digit number before the dash. Enter all group IDs that apply separated by a comma.

If you are completing this form on behalf of the company, please provide your full name.

Please print your above responses before submitting, as a copy for your records. There is a print button at the top of this page.