Issuu on Google+

2012

Employee Benefit Plan Compliance Calendar


2012 Employee Benefit Plan Compliance Calendar* Introduction ERISA (the Employee Retirement Income Security Act of 1974) is a federal law that sets minimum standards for retirement and health benefit plans in private industry. In order to ensure that employee benefit plans are operated and managed in accordance with those standards, and that participants and beneficiaries have access to sufficient information to protect their rights and benefits under their plans, ERISA includes detailed requirements for reporting to the government and disclosure to participants by plan administrators, sponsors, and employers. The 2012 Employee Benefit Plan Compliance Calendar provides bottom line information on ERISA-mandated notices, disclosures and filings— including who must provide them, who must receive them, and when disclosures are due. Please note that the applicability of certain requirements may depend on the type of employee benefit plan administered, the number of participants, or other circumstances. Additionally, your plan may be subject to other requirements that are not included in this calendar, such as certain reporting and disclosures required by the Internal Revenue Service or by state law.

What's New in the 2012 Calendar The 2012 edition of the Employee Benefit Plan Compliance Calendar incorporates a number of important updates as a result of new requirements for group health plans under Health Care Reform, including the new summary of benefits and coverage (SBC) notice requirements. The calendar was also expanded for 2012 to include certain key non-ERISA notice requirements for group health plans, including information regarding Medicare Part D Creditable Coverage Disclosures. Other additions to the calendar include new explanations for certain Pension Benefit Guaranty Corporation requirements applicable to defined benefit pension plans, as well as additional model notices for key requirements under ERISA. Health Care Reform requirements are subject to change. For the most up-to-date information, please visit http://www.dol.gov/ebsa/healthreform/.

How to Use Our Compliance Calendar The information and summaries provided in this calendar should be used for general reference purposes only. Specific requirements as to content and format with respect to individual reporting and disclosure requirements may be found in the applicable law or regulation, and are not necessarily reflected in this calendar. It is also very important to review the law for acceptable methods of delivery—for instance, notices required under ERISA typically must be furnished using "measures reasonably calculated to ensure actual receipt of the material." For convenience, links to relevant sections of the law, regulations, agency guidance and model notices have been provided in many instances where appropriate. Note that the information contained in these links is subject to change based on new government requirements or directives. Plan administrators, sponsors, employers, and other parties with obligations under ERISA should refer to the current law, regulations

*Publication Date: April 30, 2012

Š2012 HR 360, Inc. | 1


Table of Contents 2012 Required Benefits Notices Checklist ..................................................................................................................................................................... 9 Overview of Basic Notice and Disclosure Requirements for Employee Benefit Plans ................................................................................................ 12 Notice and Disclosure Requirements for Employee Benefit Plans........................................................................................................................ 13 Summary Plan Description (SPD) .................................................................................................................................................................. 13 Summary of Material Modifications (SMM) ................................................................................................................................................. 13 Summary Annual Report (SAR)...................................................................................................................................................................... 14 Notice of Benefit Determination ................................................................................................................................................................... 14 Plan Documents ............................................................................................................................................................................................ 14 Additional Requirements for Group Health Plans—Covered Benefits and Claims Information ........................................................................... 15 Summary of Material Reduction in Covered Services or Benefits ................................................................................................................ 15 Notice of Adverse Benefit Determination and Notice of Final Internal Adverse Benefit Determination ..................................................... 15 Additional Requirements for Group Health Plans—COBRA Notices ..................................................................................................................... 16 Initial COBRA Notice ...................................................................................................................................................................................... 16 Notice of Qualifying Event............................................................................................................................................................................. 17 COBRA Election Notice .................................................................................................................................................................................. 17 Notice of Unavailability of COBRA Coverage................................................................................................................................................. 18 Notice of Underpayment of COBRA Premium .............................................................................................................................................. 18 Notice of Early Termination of COBRA Coverage .......................................................................................................................................... 18 Additional Requirements for Group Health Plans—HIPAA Portability and Nondiscrimination............................................................................ 19 General Notice of Preexisting Condition Exclusion ....................................................................................................................................... 19 Individual Notice of Preexisting Condition Exclusion .................................................................................................................................... 19 Certificate of Creditable Coverage ................................................................................................................................................................ 20 Notice of Special Enrollment Rights .............................................................................................................................................................. 20 Wellness Program Disclosure ........................................................................................................................................................................ 20

©2012 HR 360, Inc. | 4


Table of Contents (cont'd) Additional Requirements for Group Health Plans—Health Care Reform (PPACA) Notices .................................................................................. 21 Summary of Benefits and Coverage (SBC) and Uniform Glossary ................................................................................................................ 21 Notice of Modification .................................................................................................................................................................................. 22 Notice of Rescission of Coverage .................................................................................................................................................................. 22 Disclosure of Grandfather Status .................................................................................................................................................................. 22 Notice of Patient Protections ........................................................................................................................................................................ 22 Notice of Participation in Early Retiree Reinsurance Program (ERRP) .......................................................................................................... 23 Notice of Waiver from Annual Limit Requirements for Limited Benefits Plans and for Stand-Alone HRAs ................................................. 23 Additional Requirements for Group Health Plans—Special Health Care Notices ................................................................................................. 24 Women's Health and Cancer Rights Act (WHCRA) Notices........................................................................................................................... 24 Mental Health Parity and Addiction Equity Disclosure ................................................................................................................................. 24 Employer CHIP Notice ................................................................................................................................................................................... 24 Michelle's Law Notice.................................................................................................................................................................................... 25 Notice Regarding Newborns' and Mothers' Health Protection Act .............................................................................................................. 25 Medical Child Support Order (MCSO) Notices .............................................................................................................................................. 26 National Medical Support (NMS) Notice ....................................................................................................................................................... 26 Non-ERISA Notice Requirements for Group Health Plans ..................................................................................................................................... 27 HIPAA Notice of Privacy Practices for Protected Health Information........................................................................................................... 27 Medicare Part D Creditable Coverage Disclosure Notices ............................................................................................................................ 27 Additional Requirements for Retirement Plans—General Benefits Information ................................................................................................. 28 Periodic Pension Benefit Statement ............................................................................................................................................................. 28 Statement of Accrued and Nonforfeitable Benefits ..................................................................................................................................... 29 Notice to Separated Participants with Deferred Vested Benefits ................................................................................................................ 29 Domestic Relations Order (DRO) and Qualified Domestic Relations Order (QDRO) Notices ....................................................................... 29 Notice of Significant Reduction in Future Benefit Accruals .......................................................................................................................... 30 Notice of Failure to Meet Minimum Funding Standards .............................................................................................................................. 30 ©2012 HR 360, Inc. | 5


Table of Contents (cont'd) Additional Requirements for Specific Types of Retirement Plans—Defined Contribution Plans ......................................................................... 31 Section 404(c) Plan Disclosures ..................................................................................................................................................................... 31 Disclosure of Plan Fees and Expenses ........................................................................................................................................................... 31 Notice of Blackout Period for Individual Account Plans................................................................................................................................ 31 Automatic Contribution Arrangement Notice .............................................................................................................................................. 32 Qualified Default Investment Alternative Notice.......................................................................................................................................... 32 Notice of Right to Divest Employer Securities .............................................................................................................................................. 32 Additional Requirements for Specific Types of Retirement Plans—Defined Benefit Plans .................................................................................. 33 Annual Funding Notice .................................................................................................................................................................................. 33 Suspension of Benefits Notice....................................................................................................................................................................... 33 Notice of Funding-Based Limitation .............................................................................................................................................................. 34 Notice of Transfer of Excess Pension Assets to Retiree Health Benefit Account.......................................................................................... 34 Additional Requirements for Specific Types of Retirement Plans—Multiemployer Plans ................................................................................... 35 Multiemployer Plan Summary Report .......................................................................................................................................................... 35 Multiemployer Pension Plan Information Made Available on Request........................................................................................................ 35 Multiemployer Plan Notice of Potential Withdrawal Liability ...................................................................................................................... 35 Overview of Form 5500 Annual Reporting Requirements for Employee Benefit Plans .............................................................................................. 36 Form 5500 Annual Reporting Requirements......................................................................................................................................................... 37 Form 5500 (Annual Return/Report of Employee Benefit Plan) .................................................................................................................... 37 Form 5500-SF (Short Form Annual Return/Report of Small Employee Benefit Plan) ................................................................................... 37 Form 5500-EZ (Annual Return of One-Participant—Owners and Their Spouses—Retirement Plan)........................................................... 38 Form 8955-SSA (Annual Registration Statement Identifying Separated Participants with Deferred Vested Benefits) ............................... 38 Form 5558 (Application for Extension of Time to File Certain Employee Plan Returns) .............................................................................. 38

©2012 HR 360, Inc. | 6


Table of Contents (cont'd) Schedules to Form 5500—General Schedules ...................................................................................................................................................... 39 Schedule H—Large Plan and DFE Financial Information ............................................................................................................................... 39 Schedule I—Small Plan Financial Information .............................................................................................................................................. 39 Schedule A—Insurance Information ............................................................................................................................................................. 39 Schedule C—Service Provider Information ................................................................................................................................................... 39 Schedule D—DFE/Participating Plan Information ......................................................................................................................................... 39 Schedule G—Financial Transaction Schedules .............................................................................................................................................. 39 Schedules to Form 5500—Independent Qualified Public Accountant's Report ................................................................................................... 40 Independent Qualified Public Accountant's Report...................................................................................................................................... 40 Schedules to Form 5500—Retirement Plan Schedules ......................................................................................................................................... 40 Schedule R—Retirement Plan Information ................................................................................................................................................... 40 Schedule MB—Multiemployer Defined Benefit Plan and Certain Money Purchase Plan Actuarial Information ......................................... 40 Schedule SB—Single-Employer Defined Benefit Plan Actuarial Information................................................................................................ 40 Overview of Pension Benefit Guaranty Corporation Reporting and Disclosure Requirements for Defined Benefit Pension Plans ........................... 41 Pension Insurance Premiums—Single-Employer and Multiemployer Defined Benefit Plans............................................................................... 43 Estimated Flat-Rate Premium Filing .............................................................................................................................................................. 43 Comprehensive Premium Filing .................................................................................................................................................................... 43 Standard Terminations—Single-Employer Defined Benefit Plans ........................................................................................................................ 44 Notice of Intent to Terminate (NOIT) ............................................................................................................................................................ 44 Form 500 (Standard Termination Notice) ..................................................................................................................................................... 44 Notice of Plan Benefits .................................................................................................................................................................................. 45 Form 501 (Post-Distribution Certification).................................................................................................................................................... 45 Distress Terminations—Single-Employer Defined Benefit Plans .......................................................................................................................... 45 Form 600 (Distress Termination, Notice of Intent to Terminate) ................................................................................................................. 45 Notice of Intent to Terminate (NOIT) ............................................................................................................................................................ 46 Notice of Benefit Distribution ....................................................................................................................................................................... 46 Disclosure of Termination Information ......................................................................................................................................................... 46 Form 601 (Distress Termination Notice) ....................................................................................................................................................... 47 Form 602 (Post-Distribution Certification).................................................................................................................................................... 47

©2012 HR 360, Inc. | 7


Table of Contents (cont'd) Other Reports—Single-Employer Defined Benefit Plans ...................................................................................................................................... 48 Form 10 (Post-Event Notice of Reportable Events) ...................................................................................................................................... 48 Form 10-Advance (Advance Notice of Reportable Events) ........................................................................................................................... 48 Form 200 (Notice of Failure to Make Required Contributions) .................................................................................................................... 48 Reporting of Substantial Cessation of Operations and of Withdrawal of Substantial Employer.................................................................. 49 Annual Financial and Actuarial Information Reporting (e-4010) .................................................................................................................. 49 Overview of Form M-1 Annual Reporting Requirements for MEWAs and ECEs ......................................................................................................... 50 Form M-1 Reporting Requirements ...................................................................................................................................................................... 51 Form M-1 ....................................................................................................................................................................................................... 51 About HR 360, Inc. ....................................................................................................................................................................................................... 52

Š2012 HR 360, Inc. | 8


Notice and Disclosure Requirements for Employee Benefit Plans—SPD ● SMM ● SAR In This Section: Summary Plan Description > Summary of Material Modifications > Summary Annual Report > Notice of Benefit Determination > Plan Documents

Document

Type of Information

Provide To

Provides plan participants and beneficiaries with information about their rights, benefits, and responsibilities under the plan and See also "Summary of how it works, in terms the average Benefits and Coverage," participant can understand, including: below, for additional  Basic rights and responsibilities notices to be provided of participants under ERISA by group health plans. (model language is available);  Eligibility requirements;  Description of plan benefits, how benefits are calculated, and when and in what form they are paid;  Applicable premiums, costsharing, deductibles, etc.;  How to file a claim for benefits; and  Notices and descriptions required under COBRA, HIPAA, and other health coverage laws.

 Plan participants

Summary of Material Modifications (SMM)

 Plan participants  Beneficiaries receiving benefits under a pension plan

Summary Plan Description (SPD)

See also "Summary of Material Reduction in Covered Services or Benefits" and "Notice of Modification," below, for additional notices required to be provided by group health plans.

Describes material modifications to the plan and changes to information required to be included in the SPD, such as changes related to the plan sponsor or administrator, eligibility rules, or benefit claims procedures.

 Beneficiaries receiving benefits under a pension plan

Provided By

When Due

Plan administrator New participants: Within 90 days of becoming covered by the plan (all plans, regardless of size)

Pension plan beneficiaries: Within 90 days after first receiving benefits Note: The SPD must accurately reflect the plan terms as of the date not earlier than 120 days prior to the date the SPD is provided, and must be accompanied by any summary of material modification or change in information required to be included in the SPD which has not been incorporated into the document being furnished.

(Plan participants and beneficiaries, as well as the DOL, also have the right to obtain a copy of the SPD upon request— see "Plan Documents," below, for requirements.)

New plans have 120 days after becoming subject to ERISA to distribute the SPD. An updated SPD must be furnished every 5 years if changes are made to SPD information or the plan is amended. Otherwise, an SPD must be furnished every 10 years.

(Plan participants and beneficiaries, as well as the DOL, also have the right to obtain a copy of the SMM upon request— see "Plan Documents," below, for requirements.)

Plan administrator (all plans, regardless of size)

No later than 210 days after the end of the plan year in which the change is adopted

Note: Timely distribution of an updated SPD or Notice of Modification (for group health plans) may satisfy this requirement.

Penalties for Failure to Comply with the Basic Disclosure Requirements for Employee Benefit Plans Employee pension and welfare benefit plans, administrators and sponsors who fail to comply with the basic disclosure requirements under ERISA may be subject to civil penalties of up to $1,100 per day and may also be held personally liable to participants and beneficiaries. The IRS may also impose a penalty tax for certain violations.

©2012 HR 360, Inc. | 13


Additional Requirements for Group Health Plans—Covered Benefits and Claims Information In This Section: Summary of Material Reduction in Covered Services or Benefits > Notices of Adverse Benefit Determination

Document

Type of Information

Provide To

Provided By

When Due

Summary of Material Reduction in Covered Services or Benefits

Summary of group health plan amendments and changes in the information required to be included in the SPD that constitute a material reduction in covered services or benefits, meaning a change the average participant would consider important—for example, changes that eliminate or reduce benefits payable, or that increase premiums, deductibles or copayments.

Plan participants

Plan administrator

Generally: Within 60 days of adoption of the material reduction in group health plan services or benefits

See also "Notice of Modification," below, for additional notices required to be provided by group health plans.

Note: Under Health Care Reform, a plan may lose its "grandfather" status if it makes certain material changes.

In addition to required disclosures described under "Notice of Benefit Determination," above, nonand grandfathered group health plans must, as part of the new rules for Notice of Final internal claims and appeals processes Internal Adverse Benefit Determination under Health Care Reform, include additional information in each notice of adverse benefit determination and final internal adverse benefit determination provided to claimants. Notice of Adverse Benefit Determination

(Plan participants and the DOL also have the right to obtain a copy of the Summary of Material Reduction in Covered Services or Benefits upon request—see "Plan Documents," above, for requirements.)

Claimants (participants and beneficiaries, or authorized claims representatives)

(all plans, regardless of size)

Alternative 90-day rule: May be provided with information about the plan that is furnished at regular intervals of not more than 90 days, if certain requirements are satisfied

Plan administrator (non-grandfathered group health plans with 2 or more participants who are current employees)

Requirements vary depending on the type of benefit claim involved and the stage of review Decisions on internal appeals generally must be provided within:  72 hours of receipt of the request for review of the denial of a claim for urgent care;  30 days for denials of urgent care not yet received; and  60 days for denials of services already received by the claimant

Note: Certain requirements with respect to these notices were delayed until plan years starting on or after July 1, 2011 or Jan. 1, 2012, such as the requirement to provide notices in a culturally and linguistically appropriate manner. Penalties for Failure to Comply with the Basic Disclosure Requirements for Employee Benefit Plans Employee pension and welfare benefit plans, administrators and sponsors who fail to comply with the basic disclosure requirements under ERISA may be subject to civil penalties of up to $1,100 per day and may also be held personally liable to participants and beneficiaries. The IRS may also impose a penalty tax for certain violations.

©2012 HR 360, Inc. | 15


Additional Requirements for Group Health Plans—COBRA Notices In This Section: Initial COBRA Notice > Notice of Qualifying Event > COBRA Election Notice > Notice of Unavailability of COBRA Coverage > Notice of Underpayment of COBRA Premium > Notice of Early Termination of COBRA Coverage Note: Group health plans sponsored by employers with 20 or more employees, including both full and part-time employees, on more than 50% of their typical business days in the previous calendar year are subject to the federal Consolidated Omnibus Budget Reconciliation Act (COBRA).* Each part-time employee counts as a fraction of an employee, equal to the number of hours the part-time employee worked divided by the hours an employee must work to be considered full time. Companies that have common ownership interests should contact EBSA or a knowledgeable attorney for issues related to headcount.

Document

Type of Information

Provide To

Provided By

Initial COBRA Notice

Notice of the right to purchase a temporary extension of group health coverage when coverage is lost due to certain qualifying events.

Covered employees and their spouses

Plan administrator

Note: The following are qualifying events if they cause a loss of coverage: For employee:  Termination of employment (other than for gross misconduct)  Reduction in hours of employment

(group health plans sponsored by employers with 20 or more employees)

When Due Within 90 days after the date group health plan coverage commences Note: Group health plans may satisfy this requirement by including the initial notice in the plan's summary plan description and giving the SPD to the employee and spouse within the time limit.

For employee's spouse and dependent child (in addition to above events):  Covered employee's becoming entitled to Medicare  Divorce or legal separation of the spouse from covered employee  Death of the covered employee  Loss of dependent child status under the plan rules (qualifying event for dependent child only) *Note: Individual states may require companies with fewer than 20 employees to provide continuation of coverage for eligible employees and dependents and/or extend continuation coverage requirements for individuals eligible for federal COBRA. Be sure to review your state's law for applicable "mini-COBRA" requirements. Penalties for Failure to Comply with the Basic Disclosure Requirements for Employee Benefit Plans Employee pension and welfare benefit plans, administrators and sponsors who fail to comply with the basic disclosure requirements under ERISA may be subject to civil penalties of up to $1,100 per day and may also be held personally liable to participants and beneficiaries. The IRS may also impose a penalty tax for certain violations.

©2012 HR 360, Inc. | 16


About HR 360, Inc. HR360 is the award-winning, attorney-reviewed online HR library featuring the most current federal and state laws and updates, plus step-bystep guidelines for compliance as well as how to hire, interview and terminate employees. HR360 also features a variety of online HR tools and hundreds of ready-to-use HR forms, policies and posters. For more information about our products please visit us at www.hr360.com or call us at 800-552-8211, ext. 1.

NOTICE OF COPYRIGHT AND RESTRICTIONS ON USE: THIS DOCUMENT IS PROTECTED UNDER THE COPYRIGHT LAWS OF THE UNITED STATES AND MAY NOT BE COPIED, REPRODUCED, REPUBLISHED, UPLOADED, POSTED, OR TRANSMITTED IN ANY WAY (ELECTRONICALLY OR OTHERWISE) EXCEPT AS EXPRESSLY AUTHORIZED IN WRITING BY HR 360, INC. THE POSTING OF THIS DOCUMENT ON THE INTERNET OR ANY OTHER FORM OF MASS DISTRIBUTION IS STRICTLY PROHIBITED.

©2012 HR 360, Inc. | 52


2012 Employee Benefit Plan Compliance Calendar