Without the necessary guidance,
The LaRocca and Associates compliance team meets with clients on a quarterly basis to review regulatory responsibilities and determine management moving forward. A pro-active approach which minimizes liability and ensures our clients are aware of and in front of benefits compliance. All included as part of our standard support package. LaRocca also provides monthly compliance and HR updates, so clients have the latest information at their fingertips. Attorney reviewed, succinct and in plain terms. The Affordable Care Act is complex managing the responsibilities it places on employers doesn’t have to be.
IS YOUR COMPANY IN COMPLIANCE?
WHAT AM I, THE EMPLOYER, RESPONSIBLE FOR?
- Form 5500 Annual Return – Employers with more than 100 participants are required to file a Form 5500 Annual return with the Federal Government. The Form 5500 reports information about the plan, its finances, and its operation. The form is filed and processed under EFAST2.
- Summary Plan Description (SPD) – ERISA requires employers to disclose to employees details of the rights and privileges extended to them within a health and welfare benefit plan. These disclosures contain model notices, plan contracts, plan fiduciary and sponsor information, Cobra, FMLA and MLR strategy. The Employee Benefits Security Administration requires the document to be delivered within a specific timeline and acceptable method.
- Family Medical Leave Act (FMLA) – Employers with 50 or more employees must establish a policy for handling qualified leaves of absence. Notifications, timetables for delivery, medical certification and hour tracking are all required.
- Section 125 – Employers who sponsor benefits on a pre-tax basis are required to maintain a written policy provided to employees.
- Section 105(h) – Non-Discrimination Testing – Self-funded plans, HRA, FSA benefits must pass key concentration, eligibility & benefits, etc. tests on an annual basis to ensure their structure does not unfairly favor highly compensated individuals, key employees or owners.
- EEO-1 Reporting – The EEO-1 Report is a federally mandated survey that collects workforce data from employers required under Title VII of the Civil Rights Act. The EEOC uses this information to enforce Federal prohibitions against employment discrimination and discriminatory pay practices. Private employers with 100 or more employees and federal contractors with 50 or more employees are subject to this requirement.
- Patient Centered Outcomes Research Institute (PCORI) – Fee for self-funded benefit plans and/or HRA’s between 2012 and 2019. Reported on IRS form 720.
- 6055 Reporting – Requirement that Health insurance issuers (self-funded benefit plans) report aspects of that plan to the government for the individual mandate (1094B Employer, 1095B Employee).
- 6056 Reporting – Requirement for Employers with 50 or more employees to report details of employee offers of coverage and cost to the Government to satisfy the employer mandate (1094C and 1095C).
- Health Insurance Portability & Accountability Act (HIPAA) – Any employer who sponsors a self-funded insurance plan including (HRA, FSA) and uses a third party to administer these programs must have HIPAA documents and policies in place.
- Medicare Part D Creditable Coverage Notices – Disclosure notices must be provided to all Medicare Part D eligible individuals who are covered under or apply for, the plans prescription drug coverage, regardless of whether the prescription drug coverage is primary or secondary to Medicare Part D. Plan sponsors must also provide details of their Creditable Coverage Disclosure notice to CMS through the CMS website on an annual basis or upon any change that affects whether coverage is creditable.
- Summary of material modification (SMM) – Amendment to ERISA SPD that becomes required if plan changes are made midyear, i.e. Addition of new plan, change in offerings, contributions or plan design, etc.
- State Specific Law/Regulation – Insurance regulations are governed on both a Federal & State Level, L&A updates and confirms our shared clients are in compliance with any State mandates where they have operations.
- Americans with Disabilities Act (ADA) – employers with 15 or more employees must make reasonable accommodations for employees with disabilities. LaRocca and Associates can assist with making these determinations and providing guidance on an employer’s obligations underneath ADA.
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