Employer or association health plans must adhere to the Reporting and Disclosure Requirements under the Employee Retirement Income Security Act (ERISA) to ensure compliance with the Affordable Care Act (ACA). These requirements aim to provide transparency and protect the interests of plan participants. Employers and associations should pay attention to certain key factors to remain ACA compliant and address any challenges that may arise. Enrollment First, Inc (EFI) provides services that ensure these requirements are met, with the involvement of Third Party Administrators (TPAs) contributing to meeting this criterion.
Relevant Items for Meeting ERISA Reporting and Disclosure Requirements:
- Summary Plan Description (SPD): Employers and associations must create and distribute an SPD that accurately communicates the group health plan, its benefits, and participant rights. The SPD must be provided to all plan participants and beneficiaries within 90 days of becoming a participant or covered under the plan. Employers and associations should pay attention to the content of the SPD, ensuring it is clear, comprehensive, and easily understandable to plan participants.
- Summary of Benefits and Coverage (SBC): The ACA mandates that employers and associations provide an SBC to plan participants and beneficiaries. The SBC outlines the plan’s coverage, costs, and other important information. Employers and associations should ensure that the SBC is easily accessible and provided in a timely manner, enabling plan participants to make informed decisions about their healthcare options.
- Form 5500 Filing: Employers and associations must file an annual Form 5500 report with the Department of Labor (DOL). This report provides information about the plan’s financial condition, operations, and investments. Proper completion and submission of the Form 5500 are necessary to ensure compliance with ERISA reporting requirements.
Challenges and Addressing Them:
Meeting the ERISA Reporting and Disclosure Requirements can present challenges for employers and associations. Some challenges include:
- Understanding the Requirements: ERISA reporting and disclosure requirements can be complex, requiring a thorough understanding of the rules and regulations. Employers and associations can address this challenge by partnering with experts like Enrollment First, Inc, who can provide guidance on interpreting and meeting these requirements.
- Timely and Accurate Completion: Employers and associations must ensure that all required reports and disclosures are completed accurately and submitted on time. This can be a time-consuming task, particularly for organizations with limited resources. Third Party Administrators, such as EFI, can assist in managing and coordinating these activities, ensuring reports and disclosures are timely and accurate.
- Keeping Up with Changes in Regulations: ERISA reporting and disclosure requirements may change over time due to updates in regulations. Employers and associations need to stay updated with these changes and make the necessary adjustments to their reporting and disclosure practices. EFI keeps employers and associations informed about any regulatory changes and assists in implementing them accordingly.
Enrollment First, Inc and ERISA Reporting and Disclosure Requirements:
Enrollment First, Inc understands the challenges employers and associations face in meeting the ERISA Reporting and Disclosure Requirements. EFI provides services that assist in meeting these requirements:
- Compliance Review and Guidance: EFI conducts a comprehensive review of the employer’s or association’s group health plan, ensuring that all relevant reporting and disclosure requirements are identified and addressed. They offer guidance on creating and maintaining accurate SPDs, SBCs, and other required documents.
- Form 5500 Filing Assistance: EFI works with Third Party Administrators to facilitate the accurate and timely filing of Form 5500 reports. They ensure all necessary information is included and assist in coordinating the submission process, reducing the burden on employers and associations.
- Regulatory Updates and Support: EFI keeps employers and associations informed about any changes in ERISA reporting and disclosure requirements. They offer ongoing support and guidance, helping organizations stay compliant with evolving regulations.
Meeting ERISA Reporting and Disclosure Requirements requires diligent attention to detail and a thorough understanding of the rules. Employers and associations can benefit from the expertise and services of Enrollment First, Inc, as well as the involvement of Third Party Administrators, to ensure compliance with these requirements.
Sources:
[1]: Department of Labor (DOL) – Employee Retirement Income Security Act (ERISA) Reporting and Disclosure [https://www.dol.gov/agencies/ebsa/employers-and-advisers/plan-administration-and-compliance/reporting-and-disclosure].
[2]: Summary Plan Description (SPD) [https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/faqs/spd].
[3]: Summary of Benefits and Coverage (SBC) [https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/faqs/aca-part-x-disclosure-of-material-modifications].
[4]: Form 5500 Overview [https://www.dol.gov/agencies/ebsa/employers-and-advisers/plan-administration-and-compliance/reporting-and-disclosure/form-5500].
[5]: Enrollment First, Inc. Home Page [https://enrollmentfirst.com/].