Is your company in compliance?
Healthcare Reform has brought substantial changes to the compliance reporting landscape and offering an employee benefit package now has many more legal obligations than it used to. Allow LaRocca and Associates and our compliance team to work with your staff to eliminate the tedious task of compliance reporting and more importantly, avoid penalties.
What is ERISA?
Employee Income Retirement Security Act of 1974 – requires that employers create legal disclosures which include model notices, rights, and privileges with respect to each health and welfare benefit plan, COBRA and FMLA rights, MLR explanation and plan of action and others. There are also certain timetables and ways in which this information must be delivered.
Doesn’t the insurance company provide this information?
No, insurance carriers adhere to state minimum requirements (where they are regulated) and ERISA is a federal law, so while similar information is provided, it would fail an audit. 401k providers only manage the qualified retirement plans and not the group benefits.
Why am I just hearing about this?
With limited resources the DOL and EBSA did little to enforce this area of the law for groups smaller than 100 employees, however, the ACA has focused the spotlight on this regulation and have considerable resources placed into its enforcement. It is the DOL’s intent to audit 75% of businesses by 2015 and 100% by 2018. As your broker, we need to bring this to your attention.
What am I the employer responsible for?
- Form 5500 Annual Return– The Form 5500 series is intended to protect the rights and benefits of plan participants and beneficiaries by assuring that: Employee benefit plans are operated and managed in accordance with certain prescribed standards. Employee benefit plan participants and beneficiaries are provided with or have access to sufficient plan information
- Summary Plan Description (SPD) – It is a legal disclosure to employees explaining the rights and privileges extended to them within a health and welfare benefit plan. It contains model notices, plan references, Cobra, FMLA, MLR treatment etc. The law itself is very specific as to the acceptable method of delivery and the timetable with which an employer has to deliver them
- 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.
- Transitional Reinsurance (ACA 1341) – Health Insurance Issuers (self-funded plans) – fee for 2014, 2015, 2016
- 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 (1095B and 1095C)
- 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.
- 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
- Summary of material modification (SMM) – If plan changes are made midyear, i.e. Addition of new plan, change in offerings, contributions or plan design, etc.