Compliance

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Rules and regulations for Health Insurance and Employee Benefits change rapidly. 
Between the Affordable Care Act, Medicare reporting, COBRA, 1094 and 1095 forms, it's almost impossible for companies to keep up with the changes.

Benefits Analysis Corporation believes it's the Broker's job to keep companies compliant.  We've invested in systems that allow us to produce compliance documents and we hired a full-time compliance officer.  We provide all compliance documents and reporting requirements to our clients for NO COST!

We're the only true full-service benefits broker in the Dayton area who provides these documents to our clients.

We also provide our clients access to a library of information to help with Human Resources , Employee Handbooks, FMLA and much more.


Below is a list of documents we provide to our clients:

ERISA Wrap Document


Many employers assume that insurance contracts for fully insured products are written plan documents. Insurance companies, however, draft their contracts to comply with state insurance laws, and, as a result, the contracts do not contain many of the ERISA-required or recommended provisions. As a result, employers must draft an entire plan document or create a "wrap" plan document to meet ERISA's requirements. A wrap plan document is designed to meet plan documentation requirements under ERISA and other federal laws and to incorporate all other welfare plans, insurance contracts, and other relevant documents into a single plan. These materials can be kept together for administrative ease. 


Summary Plan Description

ERISA requires the administrator of an employee benefit plan to furnish participants and beneficiaries with a summary plan description (SPD). An SPD describe certain provisions of the written plan document in understandable terms. Among other information, an SPD must describe:

  • Cost-sharing provisions, including premium, deductible, coinsurance, and copayment amounts for which the participant or beneficiary will be responsible
  • The extent to which preventive services are covered under the plan
  • Whether, and under what circumstances, existing and new drugs are covered under the plan
  • Whether, and under what circumstances, coverage is provided for medical tests, devices, and procedures
  • Provisions governing the use of network providers, the composition of provider networks and whether, and under what circumstances, coverage is provided for out-of-network services
  • Provisions requiring pre-authorizations or utilization review as a condition to obtaining a benefit or service under the plan

Many employers wrongly assume that documents provided by an insurance company for fully insured products satisfy the SPD requirements. As a result, employers must draft an entire SPD or create a "wrap" SPD to meet ERISA's requirements. A wrap SPD is designed to meet ERISA's requirements by incorporating and supplementing documents provided by insurance companies.  

For more information on ERISA please Follow This Link


Form 5500 Requirement

ERISA generally requires group health plans to annually file a report with the U.S. Department of Labor that contains financial and other information about the plan. This filing is made via Form 5500, and must be filed electronically by July 31 using either the IFILE web-based filing system or an approved vendor's software. Among others, the following group health plans are generally exempt from the Form 5500 requirement:

  • Fully insured group health plans with fewer than 100 participants as of the beginning of the plan year
  • Unfunded group health plans with fewer than 100 participants as of the beginning of the plan year. An unfunded group health plan has its benefits paid as needed directly from the general assets of the employer that sponsors the plan.
  • Group health plans sponsored by churches  
  • Group health plans sponsored by governments
Click here for more information on the Form 5500 requirement.


Section 125 / Premium Only Plan (POP)


A cafeteria plan is a separate written plan maintained by an employer for employees that meets the specific requirements of and regulations of section 125 of the Internal Revenue Code. It provides participants an opportunity to receive certain benefits on a pretax basis. Participants in a cafeteria plan must be permitted to choose among at least one taxable benefit (such as cash) and one qualified benefit.

A qualified benefit is a benefit that does not defer compensation and is excludable from an employee's gross income under a specific provision of the Code, without being subject to the principles of constructive receipt. Qualified benefits include:

  • Accident and health benefits (but not Archer medical savings accounts or long-term care insurance);
  • Adoption assistance;
  • Dependent care assistance;
  • Group-term life insurance coverage;
  • Health savings accounts, including distributions to pay long-term care services.

The written plan must specifically describe all benefits and establish rules for eligibility and elections.

A section 125 plan is the only means by which an employer can offer employees a choice between taxable and nontaxable benefits without the choice causing the benefits to become taxable. A plan offering only a choice between taxable benefits is not a section 125 plan.



Employee Handbook



An employee handbook is an important tool you can use to effectively communicate information regarding your company's policies, practices and employee benefits. A well-written handbook sets forth your expectations for your employees, and describes what they can expect from your company.

Let us help you build a state and federal compliant employee handbook.


1094 and 1095 Reporting



The Affordable Care Act requires insurers, self-insuring employers and other parties that provide minimum essential health coverage to report information on this coverage to the Internal Revenue Service (IRS) and to covered individuals (referred to as Section 6055 reporting). Applicable large employers (generally, those with 50 or more full-time and full-time equivalent employees) are also required to report information to the IRS and to their employees about their compliance with the employer shared responsibility (pay or play) rules and the health care coverage they have offered (referred to as Section 6056 reporting).

COBRA



The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) generally requires employers with 20 or more employees with group health plans to offer employees, their spouses, and their dependents a temporary period of continued health care coverage if they lose coverage through the employer’s plan. In the decades since federal COBRA’s passage, many states have enacted so-called "mini-COBRA" laws to allow employees who do not qualify under federal COBRA to obtain similar continuation of coverage benefits.  

For more information on COBRA please Follow This Link or contact:

  


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Benefits Analysis Corporation
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Troy, Ohio 45373
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Louisville, KY 40205
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