Compliance

Audits Happen. ThinkTank can protect you.

When you offer health benefits to your employees, you need to make sure you’re providing the right documents to stay in compliance.

There are countless rules and regulations governing employee benefit plans, many of which are complex. Our team of compliance experts will help you meet your compliance obligations and keep you up to date on laws and regulations that affect your employee benefits program.

Our compliance services include:

Compliance FAQ:

Free Compliance Assessment

Fill out the form below, and one of our compliance experts will reach out to provide you with the free compliance assessment.


Free Compliance Assessment

We know that staying in compliant is overwhelming. Our compliance experts can provide you with a free compliance assessment and audit to determine deficiencies. No strings attached.

Compliance Calendar

The Compliance Calendar is an on-demand resource that is designed to help you track and meet key federal compliance deadlines associated with the health plan you provide.

After completing a short health plan questionnaire, you will receive a customized rolling list of upcoming compliance deadlines, along with resources to help you meet those deadlines. After you set up your Health Plan Compliance Calendar, you will even receive monthly reminders about upcoming deadlines to help you stay on track.

Wrap Documents

Under ERISA, employer-sponsored welfare benefit plans, such as group health plans, must be described in a written plan document. In addition, employers must explain the plans’ terms to participants by providing them with a summary plan description (SPD).

The insurance certificate or benefit booklet provided by an insurance carrier or other third party for a welfare benefit plan typically does not satisfy ERISA’s content requirements for plan documents and SPDs.

However, employers may use wrap documents in conjunction with the insurance certificate or benefit booklet in order to satisfy ERISA’s requirements. This document is called a “wrap document” because it essentially wraps around the insurance certificate or benefit booklet to fill in the missing ERISA-required provisions. When a wrap document is used, the ERISA plan document or SPD is made up of two documents— the insurance certificate or benefit booklet and the wrap document.

ERISA Plan Document

The plan document contains a description of the terms and conditions for the operation and administration of the plan. It must be provided within 30 days of a written request.

Summary Plan Description (SPD)

The SPD contains plan information, including the benefits, rights and obligations of the covered participant. It should be written in a style and format that can be easily understood by the average plan participant. The SPD should be provided within 90 days of the participant being covered by the plan, or within 30 days of a written request.

Summary of Material Modification (SMM)

The SMM describes material changes to a plan and any changes in the information required in the SPD. An updated SPD satisfies the SMM requirement. In general, the SMM or updated SPD must be distributed to participants no later than 210 days after the end of the plan year in which the changes were made, or within 30 days of a written request. A shorter deadline may apply to health plans in some circumstances, depending on the nature of the modification or change. For example, if the change is a material reduction in group health plan benefits or services, the deadline for providing the SMM or updated SPD is 60 days after the change is adopted,

Summary Annual Report (SAR)

This report is a narrative report of the Form 5500 and includes a statement of the participant’s right to receive the annual report. Plans that are exempt from annual 5500 filing, as well as large and unfunded health plans, may be exempt from the SAR requirement. The SAR must be provided to participants within nine months after the end of the plan year. For more information on how to stay ERISA compliant, contact ThinkTank Insurance Partners.

Form 5500 Preparation

The Form 5500 satisfies various annual reporting obligations that plan administrators must meet under ERISA and the Internal Revenue Code. Form 5500 must be filed electronically with the DOL. This form is generally due by the last day of the seventh calendar month after the plan year ends. See the DOL’s website for details on this reporting requirement. Small health plans are exempt if they have fewer than 100 participants and benefits are insured or unfunded.

Compliance Bulletins

Compliance Bulletins are news alerts on important compliance developments. They provide essential information for employers, to help you keep on top of the latest legal updates.

ACA Interactive Tools

Under the ACA, employers face the risk of incurring new penalties related to the coverage they offer. Our interactive tools can help you assess your exposure to these penalties and determine strategies to minimize your risk.

Newsletters

Want to know about benefit changes at a glance? Grab a monthly or quarterly newsletter filled with concise summaries of rule changes and you’ll be caught up in no time.

Handbook

When is the last time you reviewed your employee handbook? We can provide a customized, comprehensive employee handbook that includes dozens of essential workplace policies.

Plan Design Assistance

Are you interested in exploring plan design changes or additions? We provide an encyclopedic collection of reference materials for you to explore with ease, including:

  • Plan Designs Section 125 Plans: Do You Need One?
  • Health Plan Design Benchmark Report
  • Plan Designs: Voluntary Benefits

HR Education and Rules

Compliance doesn’t stop at benefits plan rules, and neither do we. We have several tools in place to help your HR department, including:

  • HR Insights Series
  • HR Brief Newsletter
  • HR Q&As
  • HR Hotline

How does the DOL enforce ERISA?

The DOL has broad authority to investigate or audit an employee benefit plan’s compliance with ERISA. The DOL’s EBSA division handles audits of employee benefit plans. To perform these audits, EBSA employs over 400 investigators working out of field offices, many of whom are lawyers or CPAs or who have advanced degrees in business or finance.

DOL audits often focus on violations of ERISA’s fiduciary obligations and reporting and disclosure requirements. The DOL may also investigate whether an employee benefit plan complies with ERISA’s protections for plan participants. The DOL also uses its investigative authority to enforce compliance with the Affordable Care Act (ACA).

Traditionally, DOL audits of employee benefit plans have focused primarily on retirement plans, such as 401(k) plans. However, now that the DOL is enforcing compliance with the ACA, health plan audits are on the rise.

Enforcement Statistics:

During the 2016 fiscal year, EBSA closed 2,002 civil investigations. Of these, 67.7 percent resulted in monetary results for employee benefit plans or other corrective action.

In addition, EBSA filed 62 civil lawsuits and closed 333 criminal investigations. EBSA's criminal investigations led to the indictment of 96 individuals—including plan officials, corporate officers and service providers—for offenses related to employee benefit plans.

What are the possible consequences of a DOL investigation?

Being selected for a DOL audit can have serious consequences for an employer. According to a DOL audit report for the 2016 fiscal year, approximately 3 out of 5 investigations resulted in penalties or required other corrective action, such as paying amounts to restore losses, disgorging profits and ensuring claims were properly processed and paid. In addition, a DOL audit may negatively affect an employer’s normal business operations because the audit process can be both stressful and time-consuming.

The DOL has the authority to assess civil penalties for many different types of ERISA violations. Common penalty assessments involve the following:

Form 5500 violations (for example, not filing a Form 5500 when required or filing an incomplete Form 5500) The DOL has the authority under ERISA to assess penalties of up to $1,100 per day for each day an administrator fails or refuses to file a complete Form 5500. This maximum penalty amount increases to $2,097 per day for violations that occurred after Nov. 2, 2015. The penalties may be waived if the noncompliance was due to reasonable cause.
Failing to respond to participants’ requests for plan information If a plan administrator fails to respond to a participant’s request for plan documents (for example, the latest summary plan description) within 30 days, the plan administrator may be charged up to $110 per day from the date of the failure or refusal to provide the information.

ThinkTank Insurance Partners, Inc.
18521 Spring Creek Rd Unit B.
Tinley Park, IL 60477
(708) 277-9023

© 2019 ThinkTank Insurance Partners, Inc.