Compliance Stuff

Employer-sponsored group health plans operate at the intersection of multiple federal regulatory frameworks — ERISA, the ACA, COBRA, HIPAA, the Mental Health Parity and Addiction Equity Act (MHPAEA), and more. Each imposes its own documentation requirements, reporting deadlines, and operational obligations. The challenge for most employers is not a lack of intent to comply, but the sheer complexity of keeping pace with layered and frequently updated rules. A proactive, systematic compliance review conducted with legal guidance is one of the most effective tools employers have to reduce legal exposure, strengthen plan governance, and prepare for regulatory inquiries . The following overview identifies the key compliance areas that such a review should cover. Plan Governance and ERISA Documentation ERISA requires every welfare benefit plan to be maintained pursuant to a written plan document that satisfies specific requirements. Compliance reviews routinely reveal documentation gaps that...

Benefits Boost! The Short Plan Year: PCORI Fee Edition Gallagher Calculating the PCORI fee can cause unforeseen issues when there is a short plan year. Boost your PCORI fee knowledge when you have a short plan year. Reminder: PCORI Fee Due July 31 Gallagher Remember to file the updated Form 720 and pay your PCORI Fee. Review these reminders ahead of the due date. Catch-Up on Health Plan Excessive Fee Litigation Gallagher As a result of an uptick in litigation against plan fiduciaries with respect to their selection process of PBMs, health plan fiduciaries should stay vigilant. Examine how the PBM excessive fee cases are taking shape. OCR Continues to Focus on HIPAA Enforcement Gallagher Fines and corrective action plans abound as covered entities fail to comply with HIPAA Privacy and Security regulations. Review of HIPAA policies and procedures never goes out of style. How Self-Directed Brokerage Accounts Offer Your Employees More Investment Options Gallagher Self-Directed Brokerage Ac...

  If your company offers an employee benefit plan under the Employee Retirement Income Security Act (“ERISA”), you are likely required to file Form 5500. Form 5500 is an annual report that contains information about a company’s benefits, including welfare benefit plans (including medical, dental, life insurance and disability benefits), retirement plans, fully-insured plans, and self-funded plans . In this month’s Compliance Corner, we cover the essentials of Form 5500, including who is required to file, the filing deadline, and the potential penalties for failing to file. Who is Required to File Form 5500? As a general rule, plans with 100 or more participants at the beginning of a plan year must file Form 5500 with the Department of Labor (“DOL”) . Additionally, any plan funded through a trust—regardless of the number of participants—must also file Form 5500. Welfare plans with fewer than 100 participants that are either unfunded or insured (i.e., do not hold assets in trust) are...

 To round out our ERISA 50th anniversary series, this Benefits Boost focuses on ERISA’s recordkeeping requirements. ERISA requires plan sponsors to maintain all records documenting the accuracy of Form 5500 required reporting information as well as records with information that would have been required but for a reporting exemption. Because the Department of Labor (DOL) has not issued guidance on what exactly those records should be, ERISA plans have had to rely on informal remarks, court cases, and advisory opinions to determine which documents to retain. ERISA requires plan sponsors to keep records and make them available for examination for a period of not less than six years after the filing date of the Form 5500 based on those records . Where an exemption or simplified reporting requirement applies (e.g., small, unfunded employers), the records must be kept for six years after the date the Form 5500 would have been filed but for the exemption or simplified reportin...

  Congratulations! You made it to summer, that wonderful time of year when things at work (hopefully) slow down a bit and you’re able to take some well-deserved time off. Though before you Go-Go(‘s) (do you see what I did there?), be sure your July employee benefits compliance deadlines are covered.   July 29 – Summary of Material Modifications (SMM)   – Were any of your organization’s plans materially amended last year? If so, you may be required to furnish an SMM to participants (or a revised summary plan description). Those SMMs must be provided no later than 210 days after the end of the plan year in which the change was adopted. So, for a 2023 change, the SMM deadline would fall on July 29 (you get an extra day this year because 210 days falls on July 28, a weekend). July 31 – Form 5500/Form 8955-SSA  – If your organization sponsors a calendar year benefit plan with a Form 5500 filing requirement, the Form 5500 (and, if applicable, the audited financial stateme...