If the plan years are not the same, then there would be separate plans and would not be included in the same SPD. However, if the policy years are different from the plan year, then it is possible to be included. As an example, if a plan year runs from January to December (that is … Continue reading ARE HEALTH & WELFARE PLANS THAT HAVE DIFFERENT START DATES ABLE TO BE IN THE SAME WRAP DOCUMENT?
To clarify, you would like one plan under ERISA that includes the self-funded medical, along with the fully insured benefit programs. The Administrator provided you with a SPD but not a plan Document. In Determining what type of benefits are included in the ERISA plan, you must refer to the plan document instead of the … Continue reading WE ARE OR HAVE A CLIENT WHICH HAS A WRAP SPD/PLAN DOCUMENT, WHICH WAS CREATED FOR US/THEM A YEAR AGO, AND ALL OF THEIR BENEFITS AND MEDICAL COVERAGE WAS FULLY INSURED. AT THIS POINT, THEY HAVE DECIDED TO CHANGE THEIR MEDICAL TO “SELF-FUNDED” AND THE ADMINISTRATOR IS PROVIDING THEM WITH ERISA COMPLIANT SPDS. CONSIDERING WE ALREADY HAVE THE DOCUMENT COMPLETED TO INCLUDE HEALTH INSURANCE, I AM TRYING TO UNDERSTAND WHAT AMENDMENTS ARE NECESSARY WITH THE ADDITION OF THE SPD. WOULD WE NEED TO HAVE SEPARATE PLAN NUMBERS FOR THE TWO DOCUMENTS AND FILE SEPARATE 5500 FORMS?
Yes, you are correct! The provision is no longer applicable for the complete implementation of the PPACA changes. 12/1/2014 is the last plan year that will need to comply, tet he have heard that some carriers which offered earlier renewals with effective dates of 12/31/2013, could potentially extend the final compliance date to 12/31/14. Note … Continue reading WITH THE ACA, DO SPDS NEED TO SHOW CERTIFICATES OF CREDIBLE COVERAGE, OR IS IT NECESSARY TO ISSUE CERTIFICATES OF CREDIBLE COVERAGE THROUGHOUT 12/31/14?
Yes, it is advised you keep the language for 2014-2015. Although the late entrant can no longer be subject to pre-existing condition limitations, the plan can still impose enrollment requirements for any late enrollees. Such requirements include not permitting them to elect coverage until open enrollment, unless they have a special right designated to them … Continue reading SHOULD I STILL KEEP THE LATE ENTRANT LANGUAGE IN 2014-2015?
Yes, the administrator is entitled to make a reasonable charge to cover the cost of furnishing duplicate SPDs, it is advised that if doing so you request a written request from the participant for a duplicate copy.
Even if a form SPD had not been issued, they most likely distributed some plan information regarding the carrier to the participants. It is possible that it was not sufficient to be a compliant SPD, and/or may be construed that way. We recommend distributing the new SPD as soon as possible and not relying on … Continue reading WHAT IF THERE IS AN EMPLOYER PLAN THAT HAS NEVER HAD AN SPD, AND NOW THEY HAVE NEW COVERAGE GOING INTO EFFECT? DO THEY COMPLY WITH THE 120 DAY TIMEFRAME FOR NEW SPDS TO BE DISTRIBUTED? WHAT ARE THE STEPS NECESSARY TO COMPLY WITH SPD DISCLOSURE REQUIREMENTS?
Yes, it is common to have separate SPDs that can be issued for multiple benefits within a plan. However, be sure you are not referencing a “plan document” as opposed to a separate summary plan description. Employers often prefer separate SPDs for FSA benefits, due to the fact that many employees are not participating in … Continue reading CONSIDERING SEPARATE SPDS ARE ONLY REQUIRED IF THERE ARE SEPARATE PLAN NUMBERS. IF ALL PLANS ARE UNDER 501, SHOULDN’T THE FSA BE DISCLOSED IN THE WRAP? ARE WE IN COMPLIANCE?
First, you need to decipher whether these are included in the Health and Welfare plan (subject to ERISA) or if they are individualized voluntary policies purchased at the workplace. Worksite policies are frequently individual policies that fall under a safe Harbor, and are therefore not subject to ERISA regulations. If the policies are not subject … Continue reading CAN WORKSITE BENEFITS LIKE ACCIDENT, UNIVERSAL LIFE, AND DISABILITY BE INCLUDED IN AN SPD?
Yes it is possible to establish a Single Employer Plan if the companies are in the same control group, and under common control. To be considered under common control, there must be at least 25% common ownership interest. Regulations further provide that common control will fall under one of the following categories: Sibling group Parent/Subsidiary … Continue reading WHAT IF THERE ARE TWO SEPARATE CLIENTS, BOTH OF WHICH HAVE COMMON OWNERSHIP THROUGH THEIR PRINCIPALS? IS IT POSSIBLE TO COMBINE THE TWO BENEFIT PLANS? SPECIFICALLY, WHAT ERISA QUALIFICATIONS DO THEY NEED TO SATISFY TO MEET THE SINGLE EMPLOYER DEFINITION, AND IF THE QUALIFICATIONS ARE MET, ARE WE ABLE TO FILE ONLY ONE ERISA DOCUMENT?
The SPD does not specify each employee or employer contributions. Listed below is the standard language found in our documents. “The Employer and employees both contribute to the Plan. Premiums are paid to the Insurers for fully insured Benefit Programs and benefits will be paid by the Insurer in accordance with the applicable insurance contract/policy.”
