Survive a DOL Audit

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Survive a DOL Audit

  1. 1. Survive a DOL Audit! FindOut the Scoop on ERISAForm 5500s & DOL-ProofPlan Documents Lisa Allen, CAS Director, New Business Operations
  2. 2. Agenda1. ACA Upheld, Now What?2. 5500s - An ERISA Plan Necessity: Are you Filing Correctly?3. Welcome to Plan Documents 1014. Benefit Plan Compliance: Would Your Plans Survive An Agency Audit?
  3. 3. ACA Upheld, Now What?
  4. 4. Impact on Employers/Plan Sponsors –Upcoming Mandates in 2013• Form W-2 reporting requirement (for the 2012 tax year)• $2,500 limit on employee contributions to health FSAs (for plan years beginning in 2013)• Summary of Benefits and Coverage requirements (for open enrollment periods starting on or after September 23, 2012)
  5. 5. Impact on Employers/Plan Sponsors –Upcoming Mandates in 2013• Requirement for employers to notify employees of the availability of health insurance exchanges (March 2013)• Expansion of FICA in 2013 to include an additional 3.8% tax on the unearned income of high income individuals• 0.9% Medicare payroll tax increase in 2013 on high income individuals
  6. 6. 5500s - An ERISA PlanNecessity Are you Filing Correctly?
  7. 7. What is ERISA?The Employee Retirement Income Security Actof 1974 (ERISA) (Pub. L. 93-406 codified as 29USCS § 1002)A federal law that was enacted on 9/2/74 thatsets minimum standards for most voluntarilyestablished pension and health plans in privateindustry to provide protection for individuals inthese plans.
  8. 8. Does not REQUIRE plansERISA does not require that anemployer provide benefit plans, such ashealth insurance, to its employees orretirees, but it regulates the operationof a health benefit plan if an employerchooses to establish one
  9. 9. “Unintentional” ERISA plansSome voluntary benefits may be an “unintentional” ERISA plan if written on the group framework i.e. - Voluntary short term i.e. - Voluntary long term disabilityOther voluntary benefits may not be if: •Written with individual policy numbers per employee •Employer only collects after tax deductions, submit to carrierReview your plans carefully—when in doubt, seek benefits counsel
  10. 10. Who has to file?All Welfare Benefit Plans • Covered by ERISA • With 100+ participants as of beginning of plan yearMultiple Employer Welfare Arrangement (MEWA) as defined in ERISA section 3(40) must fileGovernment Entities exempt, as well as some Public Authorities (depending on funding stream)
  11. 11. A 5500 Form is:Annual Return/Report of Employee Benefit Plan • Open to public inspectionRequired to be filed by IRS & ERISA • Sections 104 and 4065 of the Employee Retirement Income Security Act of 1974 (ERISA) • Sections 6047(e), 6057(b) and 6058(a) of the Internal Revenue Code (the Code)Everyone wants a piece of the action!
  12. 12. Plan funding & benefit arrangementIn a Welfare Benefit Plan: "Insurance" means • Plan has account, contract, or policy with insurance company, insurance service, or other similar organization (such as Blue Cross, Blue Shield, or a health maintenance organization) • Includes investments with insurance companies such as guaranteed investment contracts (GICs). • Not "insurance" if sole function was administrative svcs
  13. 13. Plan funding & benefit arrangementIn a Welfare Benefit Plan: "General assets of the sponsor" means • Either plan had no assets – or - • Some assets commingled with general assets of plan sponsor prior to the time the plan actually provided benefits promised
  14. 14. Why does my SPD matter for a 5500?Every Welfare Benefit Plan requires a Summary Plan DescriptionSPD is not a benefit summary or summary of coverage that you may obtain from an insurance carrierSPD has very specific regulations and requirements, which we will discuss during “Plan Documents 101”Plans’ SPD will determine Three-digit plan number (PN)*
  15. 15. I need to file, now what?3. Order all of your Schedule A’s from your insurance carriers4. Get Credentialed so you can “sign” your electronic filing with a PIN5. Complete your Form 5500 and Schedule A’s, sign and electronically file with the DOL Your filing is due 7 months after the end of the plan year, don’t miss the deadline!
  16. 16. I need to file, now what?6. Review and Validate submitting7. Print hard copy of filing and SIGN it. New regulations require you to keep copy with “wet” signature for 7 years
  17. 17. Let’s talk Penalties!• Per day: $1100 (up to 27 days)• Per year: $30,000 (more than 27 days)• Maximum Penalty: $30,000 per year - no limitRemember this? 7 SPD’s and 7 Form 5500 Filings REALLY!?!If you don’t use a “Wrap” SPD that would be 7 late filings x $30,000 x # of years that weren’t filed!!!!
  18. 18. Wouldn’t it be nice…?
  19. 19. A Plan Document should include:• What benefits are offered• Who is eligible for those benefits• Who pays for the benefits and how• How do you elect the benefits• How you can change the elections for those benefits
  20. 20. What do you do with them?• The Plan Document must be “adopted” by the Plan Administrator/Employer• The Plan Document must be the final authority on the Plan• There is no “Plan” without the documentation
  21. 21. Summary of Benefits andCoverage (SBC) & Glossary*A new requirement required by the Affordable Care Act (ACA) whichapplies to Grandfathered and Non-grandfathered plans•Provide the Model SBC and Uniform Glossary as it applies to each plan•See: Templates and Compliance Guides • Department of Labor’s website under “Summary of Benefits and Coverage and Uniform Glossary” at: http://www.dol.gov/ebsa/consumer_info_health.html•There is also a 60-day advanced notice requirement when a health planor issuer modifies the terms of the plan or coverage•(Penalty up to a $1,000 fine per enrollee for each failure to provide)•Employees residing in NY, Bronx and Queens County must provideSpanish SBC and Glossary
  22. 22. SBC Must Be Provided• With any written enrollment application materials the plan provides (or no later than the first date the participant is eligible to enroll himself or any beneficiary in coverage)• For 2012, employers should distribute SBCs during the open enrollment that begins after 9/23/12• No later than the first day of coverage under the plan, if any changes are made to the information in the SBC provided upon enrollment• To individuals entitled to special enrollment under the Internal Revenue Code, no later than the 90 days from enrollment• Upon renewal, if applicable• Upon request (within seven (7) business days following the request)• Upon material modification (during plan year, as defined under ERISA)
  23. 23. ARE YOU READY IF THEGOVERNMENT KNOCKS?
  24. 24. Your ERISA Plans: Are They Readyfor a Government Audit?Every year thousands of ERISA-governed plans are selected for audit by governmental agencies • United States Department of Labor (DOL) • Internal Revenue Service (IRS)DOL has significantly increased audit enforcement and IRS announced it is stepping up examination and enforcement activities and plans to dramatically increase the number of plan returns audited in the current and next fiscal yearThe cynical view is that fed$ need dollar$
  25. 25. ACA—A NEW ADDITION TO THEDOL’S TOOLKIT
  26. 26. ACA ComplianceACA passed in 2010DOL now includes ACA Compliance in standard Welfare Plan AuditTwo Primary Focus Areas: • Grandfathered Status—Those Claiming & Those Not Claiming • All other rules
  27. 27. Actual Questions• Documents stating the eligibility criteria for enrolling in the Plan• A copy of the plan’s general notice of preexisting condition issues to enrollees (including any lists or logs an administrator may keep of issues notices), or proof that the plan does not impose a preexisting condition exclusion• The Plan’s Notice of Special Enrollment Rights (distributed to employees on or before the time they are offered the opportunity to enroll in the Plan)
  28. 28. Court Cases, Awards and DOL Fines(related to Welfare Benefit Plans that were not in compliance with ERISA laws)Awards & DOL fines Court Case$4,540 - Employer indifference and Estate of Fields v. Provident Life & Accidentirresponsibility led to disclosure violations Ins. Co., 26 EBC 2401 E.D. Pa. 2001)$11,550 - Failure to provide SPD after Neuma, Inc. v. AMP, Inc., 27 EBC 1983 (N.D.written notice Ill. 2002)$13,750 - Failure to provide SPD upon James Killian vs. Concert Health Plan, et. al.,written request. Maximum penalty for Case 07 C 4755employers unresponsiveness and lack ofexcuse. $110/day for 125 days.$17,475 - Employer did not have SPD; only Pisek v. Kindred Healthcare, Inc. Disabilityprovided certificate of insurance to Ins. Plan, 2007 WL 2068326 (S.D. Ind. 2007)Participant; repeatedly insisted they werethe same thing$17,550 - Failure to provide requested Plan Reddy v. Schellhorn, 38 EBC 1312 (N.D. IllDocument and SPD to Participant 2006)
  29. 29. QUESTIONS?

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