Reporting and Disclosure Checklist for Welfare Benefit Plans

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1 Reporting and Disclosure Checklist for Welfare Benefit Plans Plan Documents Certain documents including copies of plan and trust agreements, most recent SPD, annual report, any collectively bargained agreements, contract or other instruments under which the plan is established or operated. beneficiaries. Can also be requested by the DOL Plan administrator must furnish copies no later than 30 days after a written request. Copies must also be available for inspection at the administrator s principal office. Summary Plan Description (SPD) The primary source of information for participants and beneficiaries about their plan and how it operates. Should be written in plain language and explain a covered person s benefits, rights, and obligations under the plan. Should also contain certain standard language required by ERISA. New participants to a plan must receive an SPD within 90 days of becoming covered by the plan. A new plan has 120 days after becoming subject to ERISA (the plan s effective date) to distribute the SPD. Updated SPDs must be furnished every 5 years if changes have been made to SPD information or plan is amended, otherwise new SPDs are required once every 10 years. Summary of Material Modification (SMM) A summary of any material modifications to a plan and any changes in the information required to be in the SPD. Within 210 days after the end of the plan year in which the change is adopted. Distribution of an updated SPD satisfies this requirement. Summary Annual Report (SAR) A narrative summary of the financial information reported on the Form 5500 and an explanation of participant s right to receive the annual report. Automatically to participants within 9 months after the end of plan year. Where an extension of time has been granted by the IRS, 2 months after the Form 5500 due date. 1

2 Summary of Material Reduction in Covered Services or Benefits Summary of group health plan amendments and changes that would be considered a material reduction in covered services or benefits as defined in 29 CFR (d) Generally within 60 days of adoption of the modification or change in the group health plan services or benefits, but up to 90 days if the plan provides regular SMMs at 90 day intervals. Form 5500 and Appropriate Schedules Annual reporting requirement for pension and welfare benefit plans regarding their financial conditions, investments and operations. Filed with the Employee Benefits Security Administration (EBSA) Within 7 months after the end of the plan year. A 2 month extension is available by filing Form 5558 before the due date. Initial COBRA Notice Notice of right to purchase temporary extension of group health coverage when coverage is lost due to a qualifying event. Covered employees and covered spouses When group health plan coverage begins. COBRA Election Notice Notice of Unavailability of COBRA Notice to qualified beneficiaries of their right to elect COBRA coverage upon occurrence of a qualifying event. Notice to an individual who has sent a qualifying event notice to the plan administrator of the reason why they are not entitled to COBRA coverage. Covered employees, covered spouses, and dependent children who are qualified beneficiaries Individuals who provide a qualifying event notice to administrator whom are not eligible for COBRA Election notice to a specific qualified beneficiary with 14 days after the plan administrator is notified of a qualifying event. Allows up to 44 days after a qualifying event or loss of coverage to provide notice where the employer and the plan administrator are the same. Follow same timeframe to provide election notice to persons eligible for COBRA (generally within 14 days after the plan administrator is notified of a qualifying event or up to 44 days where the employer and the plan administrator are the same. 2

3 Notice of Insufficient Payment of COBRA Premium Notice to qualified beneficiaries that payment for COBRA continuation was less, but not significantly less, than the correct amount. A plan must provide a reasonable period of time (usually 30 days) to cure the deficiency before terminating COBRA. Individuals who elect COBRA coverage and pay a premium less than the full amount Notice should be sent as soon as practicable following short payment. Notice of Early Termination of COBRA Coverage Notice to a qualified beneficiary that their COBRA coverage will terminate earlier than the maximum period of coverage. Affected qualified beneficiaries As soon as practicable following the administrator s determination that continuation coverage will terminate. HIPAA Certificate of Creditable Coverage Notice to former group health plan participants documenting the length of time during which they were covered under the plan. See 29 CFR (a)(3)(ii) for information required to be on the certificate. beneficiaries who lose coverage Automatically upon losing group health coverage, becoming eligible for COBRA coverage, and when COBRA coverage terminates. HIPAA Notice of Special Enrollment Rights Notice to participants describing the group health plan s special enrollment rules including the right to enroll within 30 days of the loss of other coverage or of marriage, birth of a child, adoption, or placement for adoption. Employees eligible to enroll in a group health plan On or before the time an employee is initially offered the opportunity to enroll in the group health plan. General Notice of Preexisting Condition Exclusion A notice describing the existence and terms of a group health plan s preexisting condition exclusions and how prior creditable coverage can reduce the preexisting condition exclusion period. Group health plan participants Where a plan contains a preexisting condition exclusion this notice must be provided as part of any written application materials distributed for enrollment. If the plan does not distribute such materials then by the earliest date following a request for enrollment. 3

4 Individual Notice of Preexisting Condition Exclusion A notice explaining the determination that a specific preexisting condition exclusion period applies to an individual participant. Should include the length of the preexisting condition exclusion period, the basis of the determination, and an explanation of the appeals procedure if the individual wishes to dispute the determination. beneficiaries upon whom preexisting condition exclusions are imposed. As soon as possible following the determination of creditable coverage. HIPAA Notice of Privacy Practices for Protected Health Information Notice describing participant s rights, the plan s legal duties concerning protected health information (PHI) and the plan s use and disclosure of PHI. Initially at enrollment. Once every three years plan must notify individuals covered by the plan that a Notice of Privacy Practices is available and how to obtain a copy. Newborn s and Mother s Health Protection Act Notice A notice to all participants in group health plans that provide maternity or newborn infant coverage describing the applicable state and federal requirements relating to the minimum length of stay in connection with childbirth. Should be included in plan SPD or SMM and delivered following these timeframes. Women s Health and Cancer Rights Act (WHCRA) notices Notice describing required benefits for mastectomy-related reconstructive surgery, prostheses, and treatment of physical complications of mastectomy. Upon initial enrollment into the plan and then once each year. 4

5 Medical Child Support Order (MCSO) notice Notification from plan administrator regarding receipt and qualification determination on a MCSO directing the plan to provide health insurance coverage to a participant s noncustodial children. Affected participant, any child named in a MCSO, and the child s representative Upon receipt of MCSO administrator must promptly issue notice along with the plan s procedure for determining if the MCSO is qualified. Administrator must also issue separate notice as to whether the MCSO is qualified within a reasonable time after its receipt and determination. National Medical Support (NMS) Notice Medicare Part D Notice of Creditable Coverage Notice used by the State agency responsible for enforcing health care coverage provisions in a MCSO. Notice to all Medicare eligible participants with prescription drug coverage under their plan as to whether or not their current coverage is creditable according to Centers for Medicare & Medicaid Services (CMS) guidance. State agencies, employers, plan administrators, participants, custodial parents, children, representatives beneficiaries who are eligible for Medicare Part D Employer must either send Part A to the State agency or Part B to the plan administrator within 20 days after the date of notice. Plan administrator must promptly notify affected persons of receipt of the notice and the procedures for determining its qualified status. Administrator must complete or return Part B within 40 business days (or reasonably sooner) and must also provide this required information to affected persons. At a minimum, disclosure must be made at the following times: 1. Prior to the Medicare Part D Annual Coordinated Election Period (ACEP) beginning Oct. 15th through Dec. 7th of each year; 2. Prior to an individual s Initial Enrollment Period (IEP) for Part D, as described under (a); 3. Prior to the effective date of coverage for any Medicare eligible individual that joins the plan; 4. Whenever prescription drug coverage ends or changes so that it is no longer creditable or becomes creditable; and 5. Upon a beneficiary s request. 5

6 Medicare Part D Creditable Coverage Disclosure Notice to CMS Notice to Centers for Medicare & Medicaid Services (CMS) stating whether or not the group health plan s prescription drug coverage is creditable. Submitted to Centers for Medicare & Medicaid Services (CMS) File online 60 days after the beginning of the plan year or within 30 days of the termination of a plan s prescription drug coverage or after a change in the creditable status of the plan. Application for Retiree Drug Subsidy (RDS) & Attestation of Actuarial Equivalence CHIPRA Premium Assistance Notice Group health plans that provide retiree drug coverage and are applying for the RDS must submit a request along with an actuarial attestation that the plan s retiree drug coverage is equivalent to the Medicare Part D coverage. Application must also include a list of retirees for whom the plan may receive a subsidy. Notice to employees in North Carolina and certain other states that offer a premium assistance subsidy for eligible lowincome individuals to purchase qualified employer sponsored coverage. Provides information Submitted to Centers for Medicare & Medicaid Services (CMS) All employees residing in states where premium assistance is offered. The subsidy application and attestation must be submitted online through the RDS system at least 90 days prior to the start of the plan year. Attestation must also be provided no later than 90 days before a material change to prescription drug coverage that potentially causes the plan to no longer be actuarially equivalent. Annually on the first day of the plan year. Form M-1 Report for Multiple Employer Welfare Arrangements (MEWA) Annual filing in which MEWA provides identifying information including states in which coverage is provided, insurance information, number of participants covered, and compliance with ERISA. Filed with the Employee Benefits Security Administration (EBSA) Origination Report: Due within 90 days of originiation of MEWA. Annual Report: Generally due March 1 of the year following the calendar year for which the report is required. A 60-day extension is availlale. Information taken from U.S. Department of Labor Reporting and Disclosure Guide for Employee Benefit Plans (10/2008). 6