Small Employer
RxDC reporting deadline
Each year, we request information from our clients so we can help them meet the prescription drug reporting requirements of the Consolidated Appropriations Act (CAA), also referred to as the RxDC. Reporting this drug pricing data to the Centers for Medicare and Medicaid Services (CMS) is intended to increase prescription drug cost transparency for consumers. We will submit all data and required narratives for the benefits we administer for our fully insured, level-funded, and self-funded clients. Please note: We submit all data on an aggregate level.
We need the following from your group clients:
- If the company files Form 5500:
- Provide exact name of plan used on Form 5500
- Provide exact plan sponsor name used on Form 5500
- Provide exact IRS Employee Identification Number (EIN) used on the Form 5500 (nine- digit number)
- Average monthly premium (equivalent for SF groups) paid by employers (for plan year 2025)
- If the company does not file Form 5500:
- Provide exact plan sponsor name (name of organization used for legal and tax purposes)
- Provide exact IRS Employer Identification Number (EIN) number (nine-digit number)
- Average monthly premium paid by employees (for plan year 2025)
- Average monthly premium paid by employers (for plan year 2025)
Click here to learn more about Form 5500: https://www.irs.gov/retirement-plans/form-5500-corner
If you have additional questions regarding reporting, refer to the CMS website.
Please contact your Account Manager for any questions that you have about this process.
Dependents over the age of 26 needing to remain on policy
Remember that for a dependent over the age of 26 to remain insured on their parent's plan, the overage dependent form must be completed and submitted to Select Health for review. To be eligible, dependents must meet all three criteria listed below:
- Dependent has a medically determinable physical or mental impairment (lasting for at least 12 months) preventing them from engaging in substantial, gainful employment.
- Dependent has relied chiefly on policyholder or lawful spouse for support and maintenance.
- Dependent has continuously been enrolled in some form of medical coverage (with no break in coverage longer than 63 days) since the date they turned 26.
For questions about this process, please call Select Health Enrollment at 844-442-6020 weekdays from 8:00 am to 5:00 pm.
Mineral Broker Power Sessions for Q2 2026
Thank you to everyone who has joined a Broker Power Session. It is great to see agents looking for ways to better support their Select Health client groups and prospects.
As we enter second quarter, keep in mind that the Mitratech Mineral platform is a value-add for your Select Health Small Employer groups at no additional cost. In a market of rising costs, helping your clients understand the premium HR and compliance solution that comes with their Select Health plan is a powerful way to stand out.
These 15-minute power sessions are designed to provide you with practical talking points you can use in conversations with employer groups. Each session highlights 2-3 focus areas that may help differentiate your services, support clients’ needs, and encourage them to take full advantage of the resources available through their Select Health Small Employer plan.
What we’re covering:
April: Help Your Clients Stay Compliant Without the Headache: Inside Minerals 2026 Compliance Library
May: Protect your clients and yourself from costly mistakes with Minerals Certified HR Experts
June: Stay ahead of compliance requirements that brokers often overlook with Level Funded Plans
Registration is available via our Zoom link.
Quick action items:
- Watch & share: Short Video helping clients understand how to access their Mineral Account
- Resource check: Select Health Toolkit for Brokers
- Stay in the loop: Don’t miss important updates that are relevant to your clients. Sign up for the Mineral Newsletter here.
Individual
Data matching issues (DMIs): what agents need to know
Data Matching Issues (DMIs) are one of the most common and preventable challenges consumers face when enrolling in Marketplace coverage. Understanding how DMIs work and how to address them helps agents to protect client coverage, financial assistance, and long-term trust.
What Is a DMI?
A Data Matching Issue occurs when information on a Marketplace eligibility application is missing, incorrect, or does not match trusted data sources used by the Marketplace.
DMIs often involve:
- Citizenship or immigration status
- Annual household income
- Minimum Essential Coverage (MEC) such as Medicaid or CHIP
- American Indian/Alaska Native (AI/AN) status
When a DMI occurs, the consumer is granted temporary eligibility and must submit documentation to verify their information.
Why DMIs matter
If a DMI is not resolved on time, consumers may lose coverage or have financial assistance reduced or terminated. Agents may experience loss of commissions and client dissatisfaction. CMS data shows that agent assisted enrollments generate immigration—and income—related DMIs at rates four to six times higher than consumer self-enrollments. This places an additional responsibility on agents to get applications submitted properly the first time.
Resolution deadlines
- Citizenship or immigration DMIs: 95 days
- All other DMIs (including income): 90 days
In some limited circumstances, such as resolved citizenship DMIs, consumers may regain coverage through a Special Enrollment Period, but disruption in coverage is still likely.
The agent’s role: prevention is the best strategy
Use this checklist to reduce the risk of DMIs and resolve them quickly when they occur.
Best practices include
- Enter Social Security Numbers for everyone that has one.
- The name on the application must match the Social Security Administrations records exactly.
- If they do not have a Social Security Number, collect valid immigration documentation.
- Names on applications must match both legal and immigration records.
- Report all household income accurately, including self-employment income.
- Income DMIs are triggered when reported income differs by more than 50% or $12,000 (whichever is greater) from trusted data sources.
- Self-employed consumers should estimate income using prior earnings, recent trends, and realistic expectations.
- Verify Medicaid or CHIP enrollment or eligibility status.
- Consumers must accurately report whether they are enrolled in or are eligible for Medicaid or CHIP.
- Most Medicaid and CHIP programs count as Minimum Essential Coverage, making consumers ineligible for Marketplace subsidies.
- Documentation: accuracy matters
- Submitting documentation is required and accuracy is critical. Incorrect or misleading documentation can delay processing time, interrupt coverage, and increase the risk of loss of eligibility.
- Submit only valid, unaltered and relevant documentation.
- Avoid unnecessary application changes that reset DMI timelines.
- Ensure documents clearly address the specific DMI that is listed in the EDN
- *Remember: Agents cannot access a client’s HealthCare.gov account, but they can upload documents on their client’s behalf or clearly guide them through the process.
Helpful CMS resources:
- Household income guidance:
https://www.cms.gov/marketplace/outreach-and-education/household-income-data-matching-issues.pdf - Medicaid & CHIP qualifying coverage overview:
https://www.healthcare.gov/medicaid-limited-benefits/
CMS reference:
- Sample DMI notices:
- https://marketplace.cms.gov/applications-and-forms/notices.html
How to resolve and upload documents:
- How to resolve a DMI:
https://www.healthcare.gov/help/how-do-i-resolve-an-inconsistency/ - How to upload documents:
https://www.healthcare.gov/help/how-to-upload-documents/ - Upload troubleshooting tips:
https://www.healthcare.gov/tips-and-troubleshooting/uploading-documents/
Key Takeaway
DMIs are largely preventable. Accurate applications, prompt review of the Eligibility Determination Notice, and timely submission of correct documentation help consumers maintain continuous coverage and financial assistance and protect agent relationships and commissions. If you have any questions please contact your Account Manager.
New Short-Term Limited Duration plans now available in Utah
Select Health is pleased to announce three new High Deductible Short Term Limited Duration (STLD) plans now available in Utah. These plans provide flexible, affordable coverage options for individuals seeking temporary health insurance solutions and include preventive care benefits and PCP virtual care visits.
Short Term Limited Duration plans are designed for members who may need coverage outside of the annual open enrollment period or for a limited timeframe.
New plan options overview
5000 Short Term Limited Duration plans
- Individual Deductible: $5,000
- Family Deductible: $10,000
- Coinsurance: 50% member / 50% plan after deductible
- Designed for members seeking lower upfront deductibles with shared cost responsibility
10000 Short Term Limited Duration plans
- Individual Deductible: $10,000
- Family Deductible: $20,000
- Coinsurance: 100% covered by the plan after deductible
- Ideal for members comfortable with a higher deductible in exchange for full coverage after the deductible is met
8500 HSA Qualified Short Term Limited Duration plans
- Individual Deductible: $8,500
- Family Deductible: $17,000
- Coinsurance: 100% covered by the plan after deductible
- HSA compatible, allowing members to pair coverage with tax advantaged savings
Please note that Short Term Limited Duration plans are medically underwritten and require completion of a health questionnaire prior to enrollment. Coverage eligibility and final rates are based on the applicant’s health status.
For additional plan details, quoting information, and commissions, please review the applicable marketing materials or contact your Account Manager.
If you have any questions, please contact your Account Manager or the Select Health sales team at 855 442 0220.
Large Employer
Control costs with Care Management
Early coordination of care improves outcomes for members with chronic conditions
We use innovative predictive modeling to identify members at risk, so they can get the support they need before avoidable health problems occur. Care Management helps manage healthcare costs while improving member health outcomes with proactive support of complex, chronic conditions. This program is available to at risk members at no additional cost to the member or employer.
Why it matters
According to the Centers for Disease Control and Prevention (CDC), chronic and mental health conditions account for 90% of the United States' $4.9 trillion yearly health care spending (CDC, Chronic Disease, 2025).
How it works
Our Care Management team has specialized training to:
- Identify members with chronic conditions via referrals from Care Managers, members, or providers, or through claims data prompting outreach
- Contact members to assess needs
- Create personalized care plans
- Guide members through their healthcare experience
- Provide ongoing support, even after treatment has been completed
Employer value
Lower healthcare costs - Reduces avoidable ER visits, hospitalizations, and readmissions by guiding employees to cost-effective care
Better health outcomes - Improves adherence, self management, and ongoing support for long term stability
Stronger workforce performance - Fewer health disruptions and unplanned absences
Higher benefits value - Improves employee experience, engagement, and retention at no added cost
Common chronic conditions we support
Including but not limited to:
- Arthritis (osteoarthritis, rheumatoid arthritis)
- Autoimmune diseases (lupus, rheumatoid arthritis)
- Cancer
- Cardiovascular diseases (heart disease, hypertension, stroke)
- Chronic kidney disease
- Chronic pain conditions (fibromyalgia, chronic back pain)
- Chronic respiratory diseases (asthma, COPD)
- Diabetes
- Gastrointestinal disorders (IBD, IBS)
- Mental health disorders (depression, anxiety disorders, schizophrenia)
- Neurological disorders (multiple sclerosis, Parkinson’s disease, epilepsy)
- Obesity
Proven financial impact
Independent studies show that Care Management programs generate measurable savings for employers through:
- ~30% reduction in employee hospital admissions
- Fewer employee emergency department visits and readmissions
Get started
Members can call Care Management at 800 442 5305 or visit selecthealth.org/wellness/care-management to submit a referral.
Questions
Benefits and services vary by plan and geography. Refer to plan documents or contact your Select Health account manager.
