TASC recently hosted a Webinar discussing Small Group Business Compliance Requirements and their new solution.

Craig Sayers from TASC led the Webinar and first off, simplified the Compliance requirements for small group based on total employees.

1-19 employees

  • POP (when employer-sponsored premium payments are paid by the employee on a pre-tax basis)
  • ERISA
  • Annual ERISA and ACA Notices
  • Annual Medicare Part D Notices
  • ACA Employer Reporting (self-insured)

20-49 employees

  • POP (when employer-sponsored premium payments are paid by the employee on a pre-tax basis)
  • ERISA
  • Annual ERISA and ACA Notices
  • Annual Medicare Part D Notices
  • ACA Employer Reporting (self-insured)
  • COBRA

Statistics indicate that 90-95% of employers have at least one violation of ERISA regulations.   Many businesses have no idea that there are even Compliance requirements.   They find out about it after they receive an audit or an employee files a compliant or lawsuit.  This is really too late to set up these documents.

Space

What Employers are subject to ERISA?

  • Corporations
  • Partnerships
  • Sole Proprietorships
  • Non-Profit Organizations (Unless exempt under 501a)

Governmental and church plans are exempt from application of ERISA Title 1 (includes Indian Tribal Governments)

Sound familiar?  This is on the BCBS BPA when enrolling a group.

ERISA Title 1 applies to health and wellness benefits including:

  • Health, dental and/or vision insurance
  • FSAs – Health flexible spending accounts
  • HRAs – Health reimbursement accounts
  • Accidental death and dismemberment insurance
  • Group term life insurance
  • Short and long term disability insurance
  • Severance insurance
  • Wellness and employee assistance programs
  • Voluntary benefits offered as pre-tax benefits

Space

Key ERISA Requirements

An ERISA plan document must exist for each plan.  A wrap document including all offered benefits, is the most common.

Summary Plan Description (SPD) must be furnished automatically to plan participants.  This covers all benefits offered and is not the same as the SBC provided by the health carrier.   The SPD describes all benefits offered, including medical, dental, life, vision, etc.

Summary of Material Modifications (SMM) must be furnished automatically to plan participants when a plan is amended.

Copies of certain plan documents must be furnished to participants and beneficiaries on written request.

Employers have only 30 days to provide an SPD to an employee upon written request.   After 30 days, the employee can collect $114/day from the employer until the SPD is received. 

Illinois Continuation

Applies to groups with 1-19 employees who offer medical insurance

  • Eligible for Employees and covered dependents
  • Must be covered on the group plan for 3 continuous months before the qualifying event
  • Qualifying event includes loss of coverage due to termination of employment or reduction in hours below the minimum required by the group plan.
  • Coverage must be the same as under group plan but need not include dental, vision or prescription drugs
  • Length of continuation coverage is 12 months
  • Premiums may not exceed the group rate.

COBRA

Applies to groups with 20+ employees both insured and self-insured group health plans, EAPs, Dental, Vision, Health FSA, HRA plans

  • Eligible for employees and covered dependents
  • Employee must be covered on the group plan the day before the qualifying event
  • 2% administration fee may be added to qualified beneficiaries premium
  • Qualifying events include loss of coverage due to termination or reduction in hours as well as employee entitlement to Medicare, loss of dependent status, divorce, legal separation or death of the employee
  • Length of continuation coverage depends on qualifying event:  ( loss of employment – 18 months),  (disability extension – 29 months),   (dependents in the case of Medicare, divorce, death as well as loss of dependent status – 36 months)

Premium Only Plan (POP)

The Premium Only Plan is a Section 125 Cafeteria Plan that allows employer-sponsored premium payments to be paid by the employee on a pre-tax basis instead of after-tax.  Coverage may include:

  • Group Medical
  • Group Dental
  • Group Vision
  • Group Disability
  • Group Term Life Insurance

Both the plan document and SPD are required to legally pay using pre-tax dollars.

TASC is introducing the Compliance Trio, designed

Specifically for small group.

The Compliance Trio is a package that provides the ERISA Wrap Document, POP and COBRA/State Continuation administration services that provide peace of mind for you and your client.

This package includes:

  • Audit Guarantee
  • One Million Hold Harmless
  • Dedicated ERISA Specialist
  • A fair monthly fee with no set-up or renewal fee.
  • Available to appointed TASC providers

This is a great time to reach out to your current groups to check their compliance.  If you are not discussing Compliance with your groups, start now.  Don’t let another agent come in and talk about this important topic.

If you are working with a potential new group, be sure to discuss Compliance with them.   You do not have to be an expert at Compliance, but you should at least let your groups know that it does exist and you have a solution.

Don’t expose your groups to another agent coming in to discuss something you should have. 

Do you have questions, potential groups or current groups that need TASC?  Contact your customer service representative, Brandon Yarnes.

Brandon Yarnes, Regional Sales Director

brandon.yarnes@tasconline.com

608-316-2533