1 / 9

Wrap Plan Documents – The New Fundamental ACA Compliance Tool

Wrap Plan Documents – The New Fundamental ACA Compliance Tool. Reasons for an Employer to create a Wrap Plan Document and Distribute an SPD. Required by ERISA Combines several benefit offerings into one plan for 5500 filing or other purposes

briar
Download Presentation

Wrap Plan Documents – The New Fundamental ACA Compliance Tool

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Wrap Plan Documents – The New Fundamental ACA Compliance Tool

  2. Reasons for an Employer to create a Wrap Plan Document and Distribute an SPD • Required by ERISA • Combines several benefit offerings into one plan for 5500 filing or other purposes • Allows employer to define elements that are often inconsistent or missing in certificates issued by insurance carriers • Allows employer to create plan features that the carrier will not document in insurance certificate ACA has made them more important than ever!!

  3. Required by ERISA • Required by ERISA for ALL plans • Regardless of size or funding • But not plans that are exempt from ERISA – church and governmental plans • Informs participants and beneficiaries about their benefits, rights, and obligations under the Plan • ERISA requires that the plan documents include specific information • Statement of Rights • Plan Sponsor Name • Plan funding information

  4. Required by ERISA • Distribution Requirements for SPD • Within 120 days of implementing new group health plan • Within 90 days of enrollment in plan • Within 210 days following the last day of the 5th plan year if SMM • Within 210 days following the last day of the 10th year if no SMM Plan document must be provided within 30 days of a request • Penalties • Up to $110 per day for failure to provide • Failure to have one does not invalidate the plan • Bigger concern is when documents issued do not accurately reflect the plan’s intent

  5. Combine Several Benefit Options into One Plan • If subject to 5500 filing requirements, will allow employer to file only one 5500 (and will reduce penalties if filing is late or missed) • HRA/Medical Plan or Wellness/Medical Plan – Employer will want to have these plans combined so that you can limit COBRA on the HRA or wellness to those who elect COBRA on medical. • If the plans are separate, then participants have to be given a separate COBRA election

  6. Create Consistent Plan Features and Add missing ones • Eligibility • Medical carriers often will not customize • ACA waiting period and eligibility details • Leave provisions – each insurer or administrator will define based on their own templates and preferences • Effective date and termination of employee and dependent coverage • Usually not consistent from carrier to carrier • Plan year • Not included in most carrier certificates • Needed to determine compliance date for most ACA requirements

  7. Design Plan Features • Expand eligibility (with permission of carrier when insured or stop loss carrier if self-funded) • Limit eligibility • Spousal exclusion (and/or dependent) • Change wording to exclude those that do not comply with eligibility audit • Include wellness plan requirements • Add benefits or exclusions (with permission of carrier)

  8. ACA • Increase in DOL Audits • Increase in provider initiated claims appeals • More items that need to be documented • Waiting periods • Eligibility • Notices

  9. Questions? Comments? Polestar Benefits, Inc. 412 Jefferson Parkway, Suite 202 Lake Oswego, OR 97035 (855) 222-3358 www.polestarbenefits.com We are happy to help!

More Related