CAA Pharmacy Drug Reporting Form

The 2021 Consolidated Appropriations Act (CAA) requires group and individual health plans to report annual data to the Department of Health & Human Services, the Department of Labor, and the Department of Treasury on drug utilization, spending, and rebates.

Reporting entities must include the average monthly premium paid by members and employers beginning with 2022 calendar year data.

How to Submit Information

To be successful, health plans need to know the amount of premium contributed by employers or other plan sponsors on behalf of members. For self-funded groups, the amount of premium paid should include claims costs, administrative fees and stop-loss premiums, if applicable.

Please submit this information by April 3, 2023 utilizing the form below.

UNI_CAA_Pharmacy_Drug_Reporting

Your Name

Your Name First and Last name null

Group Name

Group Name Name of your group null

Group Number

Group Number 8-digits including leading 0’s null

Form 5500 Plan Number

Form 5500 Plan Number The 3-digit plan number reported on the IRS Form 5500 filed with US DOL.

Total dollar amount the business contributed for Group medical and pharmacy insurance (prior calendar year)

Total dollar amount the business contributed for Group medical and pharmacy insurance (prior calendar year) null

Is this information for a self-funded plan sponsor or minimum premium plan?

Is this information for a self-funded plan sponsor or minimum premium plan? null

Total Third Party Administrator (TPA) fees paid to parties other than Univera Healthcare (prior calendar year)

Total Third Party Administrator (TPA) fees paid to parties other than Univera Healthcare (prior calendar year) Includes costs in addition to Univera Healthcare admin fee that are taken into account for purposes of calculating COBRA premiums null

Is your Stop Loss Coverage with Univera Healthcare?

Is your Stop Loss Coverage with Univera Healthcare? null

Total Stop Loss Premium paid (prior calendar year)

Total Stop Loss Premium paid (prior calendar year) null
Script to Hide Titles on CAA Pharmacy Form

 

GDPR Notification Content