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Benefits Compliance & Legal Issues

Agenda Now Available – 2017 Phoenix Mid-Sized Retirement & Healthcare Plan Management Conference

The election is over and one thing everyone can agree on is that we are entering an unprecedented season of change. Your employees and your executive board are looking to you for insights regarding what lies ahead. The 2017 Phoenix Mid-Sized Retirement & Healthcare Plan Management Conference provides an opportunity for you to connect with industry leaders, benefits experts and peers for up-to-date information so you can make the best decisions for your plans moving forward.

Webinar by US Department of Labor EBSA

This one hour Webinar is FREE and open to Plan Sponsors and practitioners and is designed to encourage employers to voluntarily comply with the Employee Retirement Income Security Act (ERISA).  Webinar:  Thursday March 17, 2016 from 11:00AM – 12:00PM (PST).  Please see attached for more details and registration info, and please share with those that might be interested.

2015 DC Plan Compliance Calendar

Vanguard provides this quick reference compliance calendar for defined contribution plans with calendar-year plan years.  It includes a list of more than 30 recurring compliance and notice requirements for tax-qualified defined contribution plans for 2015.

Preparing for a Health & Welfare Plan DOL Audit

This November 2014 article in Benefits Magazine, published by the International Foundation of Employee Benefits Plans, takes an ERISA health and welfare plan step by step through a DOL audit, from the initial notification and request for documents through the investigative process.

Mistakes That May Trigger a 401(k) Plan Audit

This October 2014 article in Employee Benefit News discusses several emerging issues that companies should be aware of that might affect their benefit plans.  It includes a list of red-flag risk areas that often draw the DOL’s attention and could trigger a plan audit.

IRS Contribution/Benefits Limits for 2015

This page on the IRS website provides a table of IRC Section 415 dollar limits for pension plans and other items for tax year 2015 adjusted for cost-of-living increases.

Commentary on the Affordable Care Act’s FAQ #21

This article on the Practical Law website highlights specific issues discussed in the ACA’s October 2014 FAQ #21, including cost-sharing, reference-based pricing and the possible affect of disclosures on SPDs. The article also looks at the practical implications of this guidance for plan sponsors.

IRS Notice 2014-49: Further Guidance on Look-Back Measurement Procedures

The IRS issued guidelines on September 18, 2014, for application of the look-back measurement process for employers in two specific situations: when an employee transfers from one position to another within the same company but with different look-back measurement periods or when an employer changes the look-back measurement period for a position.

Top Five ACA Issues Employers Should Be Following

This September 16, 2014, briefing from law firm Epstein Becker Green highlights the top five ACA issues that it believes employers should be following.  Issues include litigation, employer mandate reporting and the looming Cadillac tax.

Commentary/Analysis of IRS Draft 1094 and 1095 Forms and Instructions

This web page on Practical Law provides helpful discussion and explanation of the IRS’ recently issued draft forms 1094 and 1095 in connection with reporting that employers must provide to the IRS under Sections 6055 and 6066 of the Affordable Care Act.  The article  explains which employers, including those that are self-insured, must file the forms and what sections need to be completed.

Checklist of DC Plan Participant Notices

With the 2014 plan year nearing its end, this Prudential Compliance Bullletin looks ahead at notices that may need to be provided before the start of the 2015 plan year.  The publication provides a summary of the annual notice requirements for those notices, including timing, recipients, contents, and method of delivery.

IRS Q&A on Information Reporting by Health Care Coverage Providers

This page on the IRS website provides information in Q&A format on information that healthcare coverage providers must report to the IRS under section 6055. Reporting is voluntary for 2014; for 2015, the information is required in early 2016.

IRS Draft Forms 1094 and 1095 with Instructions for ACA Information Reporting

This chronological (newest to oldest) listing of draft tax forms on the IRS website contains links to the various 1094 and 1095 forms associated with the Affordable Care Act. The 1094 and 1095 forms were posted August 28, 2014. The instructions provided with the forms are directed at Exchanges that must report enrollees in qualified health plans as well as at employers and others that provide minimum essential coverage or are subject to the employer mandate.

IRS Announces 2015 Rates for ‘Affordable Coverage’ Under ACA

Under the terms of the Affordable Care Act, large employers are required to provide affordable coverage beginning in 2015 or potentially face penalties. For 2014, the definition of affordability was set at 9.5% of the employee’s income. For plan year beginning in 2015, IRS Rev. Proc. 2014-37 sets the new limit at 9.56% of employee income.

Navigating IRS Healthcare Coverage Reporting Requirements

This Benefits Brief by Groom Law Group explains the complex new healthcare coverage reporting requirements for employers and insurers that take effect in 2016 for the year 2015. The detailed chart at the end shows who is responsible for what, when, how and to whom the information is reported.

Wellness Programs After the Affordable Care Act (Part II)

This article is Part II of a Benefits Law Alert published by Nixon Peabody LLP, with Part I posted on August 8, 2013.  Part I of the series discussed the wellness regulations released under the Affordable Care Act, which went into effect in 2014. Part II discusses compliance with other laws that govern employee wellness programs.

U.S. Treasury Releases Final Rules on Longevity Annuities in Retirement Plans

This press release provides an overview of the Treasury Department’s final rules on longevity annuities within retirement plans.  Among the modifications in the final rules, which were Issued July 1, 2014, are changes to required minimum distribution rules and an increase the maximum permitted investment in longevity annuities.

Text of U. S. Supreme Court Opinion in Burwell v Hobby Lobby

The U.S. Supreme Court ruled in its opinion of June 30, 2014, that a for-profit corporation has free exercise of religion rights, making it lawful for the corporation to be exempt from laws to which it has religious objections.

Final Master FAQs from CMS on Health Insurance Market Reforms and Marketplace Standards

This 7-page document from the Center for Medicare & Medicaid Studies provides guidance in Q&A format on the implementation of the essential health benefits and actuarial value, guaranteed availability, minimum essential
coverage, and transitional policy extensions as established by the Affordable Care Act to reform the insurance market.

IRS Final Regulations on ACA’s Employers’ Shared Responsibility Provide a One-Year Transition to Full Compliance for Large Employers

On February 12, 2014, the IRS published final rules covering employers’ shared responsibility under ACA.  Large employers, those with 100 or more employees, will be subjected to penalties if they fail to cover 70% of full-time employees in 2015. The coverage threshhold moves to 95% in 2016. Employers with 50-99 employees have until 2016 to comply.

Complying with New HIPAA Certification Requirements

This February 2014 Benefits Brief by Groom Law outlines important dates and steps health plans must take to comply with new HIPAA Certification Requirements under recently issued rules by the Department of Health and Human Services.  The Brief also discusses Standard Transaction Rules as amended under the Affordable Care Act.

Summary of Final Mental Health Parity Regulations

This Towers Watson Insider offers analysis of the final regulations governing the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and, in particular, how the MHPAE interacts with PPACA.

ACA’s 2015 Transitional Reinsurance Fees

This Dec. 30, 2013, Towers Watson publication provides information on HHS’ announcement of the fee and payment schedule for the Transitional Reinsurance Fee assessed on insurers and plan sponsors to stabilize premiums in the individual market. The fee for 2015 has been set at $44 per covered life; self-insured and self-administered plans are exempt for 2015.

2014 IRC 415 Dollar Limitations on Benefits and Contributions

This page on the IRS website provides a table specifying the IRC 415 limits for 2014. Essentially, deferral rates for defined contribution plans are unchanged. The chart includes COLA changes for annual compensation, HCE threshold, taxable wage base, etc.

Modification of FSA Use-It-Or-Lose-It Rule

This IRS announcement on October 31, 2013, explains modification of the use-it-or lose-it rule for FSAs. Employees may carry over $500 of unused amounts from 2013 to 2014, provided the plan sponsor amends the plan to permit participants to do so.

Affordable Care Act – FAQ #16

This set of FAQs for implementation of the Affordable Care Act covers notices to employees about coverage available through Exchanges and the 90-day waiting period limitation.

ACA’s Impact on Account-Based Health Plans

The DOL’s Technical Release No. 2013-03 provides guidance on ACA’s market reforms on HRAs, FSAs, EAPs and certain other employer-provided healthcare arrangements.

Definition of “Spouse” and “Marriage” under ERISA and the Supreme Court’s Decision in United States v. Windsor

The DOL’s Technical Release No. 2013-04 provides guidance for employers on the definition of “spouse” and “marriage” in connection with their benefit plans.  The release states that, in general, the two terms in Title I of ERISA and in related department regulations should be read to include same-sex couples legally married in any state or foreign jurisdiction that recognizes such marriages, regardless of where they currently live.

ACA’s Impact on Wellness Programs

This Alert from law firm Nixon Peabody is the first of two dealing with compliance issues for employer-provided  wellness programs. This issue deals with how the ACA’s final rules amended and expanded the HIPAA nondiscrimination and wellness provisions.  These final rules apply to all group health plans, regardless of whether they are grandfathered or non-grandfathered, insured or self-insured, for plan years beginning on or after January 1, 2014.

FMLA – Fact Sheet #28F – Qualifying Reasons for Leave

This Fact Sheet on the DOL website clarifies that for purposes of FMLA the definition of spouse includes a same-sex spouse if the marriage is recognized under the laws of the state in which the employee resides.

Corrected Template – Summary of Benefits and Coverage

A revised template of ACA’s Summary of Benefits and Coverage is available on the DOL website. The revision includes two additional questions: “Does this plan provided minimum essential coverage?” and “Does this plan meet the minimum value standard?” The revised template is to be distributed during the open enrollment period for plan year 2014, or 30 days before the beginning of the plan year for plans without an open enrollment period.

EBSA FAB 2013-02 Extends Time for Comparative Charts

EBSA issued this Bulletin July 22, 2013, extending the time frame by which sponsors of participant-directed retirement accounts must provide charts comparing plan investments to participants. Instead of a specific date, plan sponsors will be given a 35-40 day window to provide this information for 2013 and 2014. EBSA is considering a regulatory amendment that replaces the current specific date requirement with this window for annual disclosures and delivery of the comparative charts.

Paying Employee Benefit Plan Expenses from Plan Assets

This article from Groom Law describes the types of expenses that may and may not be paid from the assets of an employee benefit plan. It also explains among other things the difference between fiduciary and settlor activities and expenses and the consequences for improper use of plan assets to pay plan expenses.

Guidance on the Notice to Employees of Marketplace Coverage Options

The Department of Labor issued this May 8, 2013, Technical Release to provide background and instructions on employers’ responsibility to notify employees of healthcare coverage options available through state exchanges or “marketplaces.”

Model Notice of Coverage Options for Employers Who Offer Health Care Benefits

The DOL provides a model notice of coverage options for employers who offer health care benefits, as mandated under the Affordable Care Act, to let employees know about the availability of insurance exchanges, or marketplaces. The notice is in Q/A format. It includes a form that employees who want to buy insurance through an exchange must complete.

Model COBRA Notice Updated for ACA

The DOL has provided a revised model COBRA Notice for use by single employer health plans. The new model includes language to make beneficiaries aware of alternative coverage available through ACA’s marketplaces.

PPACA’s Out-of-Pocket Maximums and Preventive Services

This analysis from Towers Watson examines the implications of the 20 questions included in the DOL’s Frequently Asked Questions #15.  The analysis focuses on out-of-pocket limits for 2014, preventive services without cost sharing and changes that may be necessary for most plans in order to be compliant.

Impact of ACA’s 90-Day Enrollment Waiting Period Rules

This March 2013 commentary from Aon Hewitt discusses the ACA’s proposed regulations limiting enrollment waiting periods for group health plans to no more than 90 days. The article also highlights the fact that after 2014 there will no longer be a need to issue HIPAA Creditable Coverage Certificates.

Affordable Care Act – FAQ #14

This set of frequently asked questions on the DOL website covers updates to the Summary of Benefits and Coverage (SBC) that include information on minimum essential coverage and minimum value of the plan’s benefits.

Summary of HIPAA Privacy Rule

The Department of Health and Human Services provides a summary of the HIPAA privacy rule on its website.

DOL Self-Compliance Tool for ERISA Part 7 – HIPAA

This self-compliance tool issued by the DOL is useful for group health plans, plan sponsors, plan administrators, health insurance issuers, and other parties to determine whether a group health plan is in compliance with some of the provisions of Part 7 of ERISA.

Affordable Care Act – FAQ #13

This set of frequently asked question (FAQ) clarifies the extent expatriate group health insurance coverage is subject to the provisions of the Patient Protection and Affordable Care Act.

DOL Field Assistance Bulletin 2013-01, MAP-21 Funding

This memorandum provides guidance on compliance by single-employer defined benefit pension plans with section 40211(b)(2) of the Moving Ahead for Progress in the 21st Century Act (MAP-21). This section of MAP-21 amended the annual funding notice requirements of section 101(f) of ERISA to require additional disclosure of the effect of segment rate stabilization on funding.t plans. This field assistance bulletin also includes a supplement to the model annual funding notice that plan administrators may use to comply with these new requirements.

Impact of ACA’s 90-Day Enrollment Waiting Period Rules

This March 2013 commentary from Aon Hewitt discusses the ACA’s proposed regulations limiting enrollment waiting periods for group health plans to no more than 90 days. The article also highlights the fact that after 2014 there will no longer be a need to issue HIPAA creditable coverage certificates.

IRS February 2013 Employee Plan News

This is the February 2013 edition of a periodic newsletter the IRS publishes. In this issue is information on how new revenue correction procedures affect 403(b) plans, updates on compliance projects and more.

Final Rule for Health Insurance Market Reforms

This overview on the Department of Health and Human Services website explains the final rules on health insurance market reforms: Guaranteed Availability of Coverage; Fair Health Insurance Premiums; Single Risk Pool; Guaranteed Renewability of Coverage; Catastrophic Plans; and Updating Rate Review.

Essential Health Benefits: Fact Sheet

The Department of Health and Human Services issued final rules on February 20, 2013, outlining standards for coverage of essential health benefits (EHB) and the determination of actuarial value (AV). This fact sheet provides an overview.

Affordable Care Act – FAQ #12

This set of FAQs on the DOL website addresses the limitations on cost-sharing and coverage of preventive services.

Affordable Care Act – FAQ #11

This set of FAQs on the DOL website addresses the employer notice of coverage options, health reimbursement arrangements, disclosure of information related to firearms, employer group waiver plans supplementing Medicare Part D, fixed indemnity insurance and payment of PCORI fees.

2014 DC Plan Compliance Calendar

Vanguard provides this quick reference compliance calendar for defined contribution plans with calendar-year plan years. The deadlines in this calendar are for plans with calendar-year plan years.

Proposed New Wellness Program Rules

This report by Aon Hewitt discusses proposed rules on wellness programs under ACA and their interaction with HIPAA’s nondiscrimination rules.

Guide to Common Qualified Retirement Plan Requirements

This page on the IRS website, updated in October, 2012,  lists some of the more important retirement plan requirements to ensure that employer-sponsored plans maintain their qualified status under IRS rules.

PBGC Premiums – 2014

This page on the PBGC’s website provides a table of the premium rates for 2014 as well as links to other information and resources available from this federally mandated pension insurance program.

Affordable Care Act – FAQ #10

FAQ #10 provides additional clarification on the implementation of the summary of benefits and coverage (SBC) for Medicare Advantage Plans.

MAP-21 – DB Interest Rates and PBGC Premiums

This August 2012 Sibson Consulting Bulletin discusses the Moving Ahead for Progress in the 21st Century Act signed into law in July. The law provides funding rate interest stabilization for defined benefit plans and also increases PBGC premiums. The Bulletin provides an overview and identifies implications for plan sponsors.

Participant-Level Retirement Plan Fee Disclosure Regulation – FAQs

This Field Assistance Bulletin (No. 2012-02) from Department of Labor’s Employee Benefits Security Administration contains frequently asked questions and answers about the Department’s participant-level fee disclosure regulation (29 CFR § 2550.404a-5). It also answers questions about related plan-level disclosures under 408(b)(2).

FMLA – DOL’s Online Access to Information About Rights and Responsibilities

This page on the DOL’s Wage and Hour Division website is part of the elaws program. This Family and Medical Leave Act Advisor provides information about the basic rights and responsibilities of employees and employers under FMLA. It includes information about the 2012 expansion of rights for military families and airline flight crews.

EBSA – Fee Disclosure Failure Notice

This page on the EBSA website outlines action a plan sponsor can take to avoid a prohibited transaction when a plan service provider fails to disclose fee information it is required to under 408(b)(2). The page contains a link to a model notice of covered service provider’s failure to comply as well as links to a 408(b)(2) Fact Sheet and Final Regulations.

EBSA – Understanding Retirement Plan Fees and Expenses

EBSA has provided an easy-to-read article for retirement plan sponsors on its website in conjunction with the February 2012 publication of 408(b)2 plan-level fee disclosures. The article includes explanations of the major categories of fees and basic information on investment fees. There are also links to several other supporting publications, most notably a link to a model 401(k) plan fee disclosure form.

EBSA – Sample Completed Summary of Benefits and Coverage

The DOL’s EBSA has provided a sample completed Summary of Benefits and Coverage (SBC) using the template the agency developed. The SBC is the four-page summary mandated by the Patient Protection and Affordable Care Act.

Uniform Glossary of Health Insurance and Medical Terms

This DOL/EBSA website has created a four-page glossary of health insurance and medical terms as a companion to the Summary of Benefits Coverage that must be provided to all plan participants under PPACA.

Interim Final Rules – Coverage of Preventive Services Under ACA

This link to the Federal Register provides the text of the interim final rules for group health plans and health insurance issuers regarding the coverage of preventive services under the Patient Protection and Affordable Care Act. The publication also includes a request for comments.

Genetic Information Discrimination – EEOC

This EEOC link discusses the prohibition against using genetic information under the Genetic Information Nondiscrimination Act of 2008 (GINA) to discriminate against employees and applicants.

GINA – Final Regulations

On November 9, 2010, the EEOC published a final rule in the Federal Register to implement Title II of the Genetic Information Nondiscrimination Act of 2008 (GINA).

FMLA for Military Families

Hewitt Consulting explains the October 2009 amendment to the Family and Medical Leave Act that expands FMLA provisions for military families.

Affordable Care Act – FAQ #2

This is the second set of frequently asked questions issued by EBSA.  Topics covered include grandfathered plans, dental and vision, rescission and preventative health as well as ACA’s effective date for individual health insurance policies.

W-2 Health Care Coverage Reporting Relief

The IRS notice states that it is not mandatory for employers to report the cost of health care coverage on W-2 forms for 2011 as initially proposed under the Affordable Care Act.

Affordable Care Act – FAQ #1

This is the first of a number of sets of frequently asked questions that the Department of Labor’s EBSA has available on its website.  These FAQs address implementation topics covering compliance, grandfathered plans, claims, internal appeals, external reviews, dependent child coverage, out-of-network emergency services and highly compensated employees.

Compliance Assistance for Health and Retirement Plans

This section of the EBSA site provides useful tools and a wealth of information for ensuring that your health and retirement plans adhere to federal regulations.  It also includes FAQs, Model Notices and other information on a broad array of plan management issues.

Fiduciary Checklist for Retirement Plan Sponsors

This is a synopsis of prudent fiduciary practices as articulated by former Department of Labor/EBSA litigator Sherwin Kaplan. The list is not all-inclusive, but is a good place to start.