770-449-7369 / Fax: 770-449-1093 info@cdainc.net

Now that we know that there will not be a swift dismantling of the Affordable Care Act I believe it is time to address the compliance issues currently facing all employers who offer benefits to their employees. The DOL is rumored to have plans to conduct more ERISA compliance audits and we are all at risk of being chosen as victims.

  1. Each of us needs to address our company’s Section 125 plan. If employee costs are being treated on a pre-tax basis we need to be sure that we have a written document in place which addresses all benefits being offered and which has had the latest amendments executed.
  2. As employers we are required to provide a Summary Plan Description (SPD) under ERISA. This document must include specific information about what the plan covers, how it operates, how employees can take advantage of their benefits once they have enrolled, how they can file a claim, and finally, the process for appealing denied benefits.
  3. The Summary of Benefits and Coverage (SBC) may appear similar to the SPD, but it is not the same document and both need to be provided to our employees. The purpose of the SBC is to provide individuals with standard information so they can compare medical plans.
  4. A Summary of Material Modifications must be provided to every plan participant covered under the plan when “material modifications” have been made to a plan other than at the time of renewal. Material modifications include amendment provisions that establish new benefits, take away existing benefits, narrow or expand the circumstances under which benefits are paid, and terminate the plan entirely.
  5. Benefits Notices must be provided to all employees and include, but are not limited to: CHIPRA: Children’s Health Insurance Program Reauthorization Act; HIPAA : the Health Insurance Portability and Accountability Act; Availability of Health Insurance Marketplace Notices; Medicare Part D Creditable (or Non-Creditable) Coverage Notice;  Grandfathered Plan Status Notice, and WHCRA : Women’s Health and Cancer Rights Act of 1998.

Please contact your benefits broker to be sure you are compliant in each of these areas. Ignorance of the rules does not exempt us from the penalties that come with non-compliance and good intentions will not prevent heartache when we are contacted for an audit. If you need assistance with any of these action steps, don’t hesitate to reach out to us at CDA, Inc. We are here to help!