When to Say Goodbye to Your Benefits Broker

For many businesses, the process of choosing and administering a health insurance benefits program is a daunting one. They often turn to benefits brokers to help them select and implement plans.

Traditional benefits brokers offer assistance in choosing plans, but typically lack the technological systems and solutions that help companies operate more efficiently and save money. In contrast, technology-backed brokers can use a variety of resources to not only aid in the selection of a health insurance plan, but to administer it and provide year-round support. Ultimately, a benefits broker should make the job of a company’s human resources (HR) department easier. If a broker is not achieving this goal, it may be time to investigate options for a new broker.

What Is A Broker?

Benefits brokers are licensed professionals who assist companies, small business owners, individuals and families in choosing and administering health insurance plans. Using their health insurance expertise, they help businesses choose health insurance networks and plans that fit their needs and budget. In many cases, brokers have long-standing relationships with their clients and can assist them with paperwork, compliance, and annual renewals.

What A Broker Should Be Doing

Establishing a comprehensive health insurance package for employees can be a challenging task for any business owner. With a seemingly endless array of choices, complicated enrollment procedures, and ever-changing legal requirements, even seasoned HR professionals may find the task overwhelming. For this reason, many companies turn to a benefits broker. Taking advantage of a broker’s expertise in plan options, procedures, and rules is a smart choice for business owners. A good benefits broker will make sure that a client has the best benefits package for their needs and budget, and will reduce the workload for an HR department by handling the plan’s administration and paperwork. Part of this process is helping to ensure that you are aware of the types of plans and costs that your competitors are employing, as a part of the benchmarking process.

Utilize Technology Systems and Solutions Appropriately

One of the ways that brokers should be assisting their clients is through the use of technology solutions and systems. Utilizing technology to select and administer a benefits program can streamline the process, ensure compliance with rules, and verify that plan information is readily accessible to both the client and its employees.

A benefits broker should use innovative technology to help clients compare and select plans, educate employees about plan options, send customized open enrollment communications, and comply with all applicable rules and regulations. Specialized programs and applications can reduce paperwork and provide easy access to necessary information.

Provide Help Throughout the Year

Brokers should also be available to their clients throughout the year, offering support for problems or questions that arise about health insurance plans. A good broker will have sufficient staff to provide year-round assistance to clients—not only when it is time to renew a plan. If a company has an employee with a major health problem or life event, for example, a benefits broker should be available to discuss these issues – as well as assisting with other routine questions, and employee education related items.

Provide Assistance in Selecting Health Insurance Programs

When it comes to selecting a health insurance programs, a broker should have access to a variety of products and plans offered by a number of carriers to meet a business’ needs and budgets. Brokers with limited options often cannot respond to their clients’ requirements, leaving companies with health insurance plans that are too expensive or that just do not meet employees’ needs. A top ranked broker brings more to clients by way of leverage – including the ability to help troubleshoot challenging situations that may arise throughout the year.

Explain and Support Compliance

Finally, because the rules and regulations surrounding health insurance plans are complicated, a good benefits broker should protect their clients on all applicable compliance and regulatory issues. This includes making sure that the plan complies with all federal and state laws and regulations, that it is offered to all eligible employees and filing the required paperwork with the IRS and other government agencies. These tasks are important and necessary but may overwhelm an HR staff. A benefits broker should take on this work for clients, easing the burden of administering a health plan – including the tools, and invaluable resources, often through on-staff HR professionals to assist with local, federal, and ACA compliance support.

Is It Time for a New Broker?

A benefits broker should be doing a variety of things to meet client needs, including offering technology-based systems and solutions, offering a range of plan options, providing year-round support, and protecting clients on regulatory and compliance issues. If a broker is not doing any of these tasks, companies should consider finding a broker who can meet their needs.

Companies who are not adequately supported by their brokers may find that their business is negatively impacted. HR professionals may feel stressed and overworked if a broker is not providing assistance in administering a health insurance program, which may ultimately lead to a high turnover rate.

Without technology-backed solutions, plan administration may be over costly and time-consuming. Employees may also be dissatisfied if they do not have their preferred health insurance options, or if they feel that they do not have access to the information that they need and want about their benefits.

If a broker is not offering a range of plans and carrier options, a company may not even be aware of lower-cost plans or plans that meet their needs better. If a broker is not assisting a business with compliance, the company may be penalized through fines and penalties for not filing the correct forms with state or federal government, or even through missed opportunities to lower their tax burden.

The Advantage of Technology-Backed Brokers

When it comes to selecting and administering a health insurance plan, using the proper technology is key. The world of health insurance is a fast-changing one, with evolving laws and market conditions that make it hard for the average business owner to keep up with the changes.

A good benefits broker should deliver expertise on a broad variety of topics, from compliance with the Affordable Care Act (ACA) to tax matters and benefits administration. A good broker should also stay on top of changing regulations and premium rates for their clients. Given the complex nature of health insurance benefits, brokers which provide ease of access to technology-backed systems and solutions offer many advantages over traditional brokers.

Compliance Needs

One such advantage of working with a broker can be seen in how brokers handle compliance with the ACA. While health care reform has provided more affordable insurance options for individuals and employers, it has also brought many rules and regulations. Employers need to determine how many full-time employees they have, ensure that their health insurance plans have the minimum value, determine what they have to report to the IRS, and then make sure that the proper paperwork is filed in a timely manner.

Failing to comply with these regulations can trigger compliance violations, resulting in penalties and missed tax savings. Traditional brokers do not provide support to their clients on these matters, leaving businesses on their own when it comes to navigating this complicated system. However, a technology-backed broker may be able to provide valuable resources to their clients to ensure compliance and help avoid any potential penalties. These tools can help employers save time and money, and allow companies to focus on what is really important—running their business smoothly and profitably.

HR Needs

Beyond compliance, technology-backed brokers may also be able to assist employers with their human resources needs. Traditional brokers are not seasoned in the field of human resources, leaving clients on their own to create their own HR policies and draft an employee handbook. They often do not provide HR support for their clients, and cannot answer questions on thorny HR issues.

In contrast, technology-backed brokers may give their clients access to a wealth of information and resources to assist their human resources team. This could include topical articles on issues that are relevant to employers, forms, sample employee handbooks and communications tools. Utilizing these tools could help an employer avoid claims of wrongful termination, discrimination, and harassment. Technology-backed brokers may also offer support on HR issues to help their clients successfully handle any problems that arise. In this way, technology-backed brokers have a distinct advantage over traditional brokers.

Pre-Renewal Planning Ahead of the Curve

When it comes to providing support, most traditional brokers limit their client contact to renewal time. Employers are left to navigate compliance and HR issues on their own, with little to no ongoing support from their brokers. Unlike traditional brokers, technology-backed brokers understand how important year-round support is to companies.

They may help clients develop strategic plans to lower costs, such as designing employee wellness programs or encouraging healthy employee behavior and habits. Technology-backed brokers may help clients choose the best benefits and support them through the open enrollment process, offering customized communications and education to increase employee participation in the plan. They understand that benefits are about more than just complying with the law; benefits can be a valuable recruiting tool and a way to improve employee satisfaction and retention. With that in mind, technology-backed brokers may provide year-round support and compliance information, ensuring that clients are never left to struggle with plan administration on their own.

Comprehensive Open-Enrollment Support

The advantages of working with a technology-backed broker can be seen in one of the most stressful parts of plan administration for HR professionals: open enrollment. A technology-backed broker may be able to set up an automated enrollment process, which eliminates the expense and hassle of distributing and collecting paper enrollment forms.

It also improves the overall efficiency and accuracy of the process. Using online enrollment typically shortens the enrollment cycle, as employees can learn about their benefits options, compare costs and coverage, and pick plans based on their eligibility for different options.

Employees can complete the enrollment process independently, finding answers to questions directly on the enrollment site, and can review their benefits information and report life changes at any time, without the involvement of the HR department. Online enrollment also simplifies plan administration, with elections, applies directly to employee records. Employees can readily view and update their records and plans, and the HR department can check enrollment status in real time. Depending on the program used, they may also be able to generate detailed reports on the cost of employee benefits.

Plan Designs and a Discerning Benchmark Analysis

Technology-backed brokers also have an advantage when it comes to initial plan selection. Traditional brokers will research plans, provide quotes and negotiate rates, but they often fail to do a deeper analysis to help companies design a competitive health insurance plan. Having a health plan that is comparable or superior to what other companies in a given industry or region is critical to recruitment and retention of top employees.

A technology-backed broker could perform a benchmarking analysis to determine what others in a given industry or area are providing for their employees, which can help companies choose plans that will give them a competitive advantage. Technology-backed brokers may also utilize programs to project the impact of medical, vision and dental plan changes, estimated renewal cost and streamline the selection process for employees.

Using the right technology to choose and implement a health insurance program through a benefits broker should help a company offer a competitive, cost-effective benefits package to its employees.

Data Analysis and Plan Comparisons

Finally, technology-backed brokers may utilize online systems to analyze clients’ plan data to determine how to adjust plans to save money. These programs may also be able to model recommended changes so that clients can see how suggested changes could save money or provide better benefits for employees. In contrast, traditional brokers do not have the analytical tools or technology to dig into plan data and identify areas for improvement.

Employers who use traditional benefits brokers will never see how their plan data compares to others in the industry, and may waste money. In this manner, technology-backed brokers may help their clients tighten their benefits budget.

In Conclusion

When it comes to selecting and administering a health insurance plan, a benefits broker should make life easier for clients. If a company is not receiving year-round support and access to technology to manage their health benefits, it may be time to look for a new broker. An experienced, knowledgeable, and highly dependable technology-backed broker such as those working at Business Benefits Group is a fantastic option for most companies—offering a range of services to help save our clients time and money, and allow them to focus every effort on running their business. Contact Benefit Administration Group to learn more.

 

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The New Summary of Benefits and Coverage (SBC)

As open enrollment season approaches, employers and their advisors are getting ready to use the new Summary of Benefits and Coverage (SBC) format required under federal rules. The basic rules have been in place for several years, but 2017 is the first year that health plans must use newly updated templates and instructions to create their SBCs.
This article answers frequently-asked questions about the SBC and what you need to do as the employer sponsor.

 

1. What is the Summary of Benefits and Coverage (SBC)?

The Summary of Benefits and Coverage (SBC) describes the plan’s benefits and limits, provides contact information, and illustrates hypothetical coverage scenarios in a standardized format. Using templates and instructions provided by federal agencies, health insurers and employers insert case-specific information to create an SBC for their plan. See a sample SBC.

The SBC is sometimes called the uniform four-page summary, although it may be longer due to double-sided pages. The format requires presenting specific information in a specific order which is intended to help employees easily understand the plan’s key features and compare different plans.

 

2. Who is responsible for the SBC? The insurance company or the employer?

Group health plans are required to provide the SBC to plan participants before enrollment or re-enrollment. For plans provided through group insurance, the insurance carrier is responsible for producing the SBC and providing it to the plan administrator (employer). Both the insurer and employer are responsible for distributing the SBC to the plan participants. Either one may handle the distribution, but the employer needs to ensure it is done.

For self-funded health plans, the plan sponsor (employer) is responsible for producing and distributing the SBC. Most self-funded employers choose to contract with their third-party administrator or claims administrator for this service, but the employer retains ultimate responsibility for compliance.

3. Is an SBC required for every health plan? If the employer offers multiple plans, can the information be consolidated into a single SBC? 

An SBC generally is required for any health plan providing medical benefits, but not for plans that primarily provide excepted benefits. For example, SBCs are not required for the following:

  • Limited-scope stand-alone dental and/or vision plans;
  • Health Flexible Spending Accounts (HFSAs) with little or no employer contribution;
  • Fixed-indemnity or specific-disease policies;
  • Long-term care, disability or accident coverage; or
  • Retiree-only plans.

A separate SBC is required for each health plan that can be chosen for enrollment. For instance, if the employer offers one PPO plan and two HMO plans, there will be three separate SBCs. A consolidated summary describing multiple plans may be helpful to employees, and may be provided in addition to the SBCs, but cannot take the place of the required SBCs.

Different options within a plan can be shown on the same SBC provided the information is clear. For instance, different coverage levels (self/family) or different cost-sharing options (high deductible/low deductible) can be presented in the same SBC as long as the remainder of the coverage information is very similar.

4. Is an SBC required for a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA)?

A Health Savings Account (HSA) is a savings program—not health plan—so no SBC is required. However, a High Deductible Health Plan (HDHP), which sometimes is called an HSA-compatible plan, is a health plan requiring an SBC. Employers that contribute to their employees’ HSAs may want to show that information on the HDHP SBC.

A Health Reimbursement Arrangement (HRA) is a group health plan. In almost all cases, the HRA is integrated with another plan, such as a major medical plan or HDHP. Employers usually choose to include information about HRA amounts, and how they reduce deductibles or other cost-sharing, on the medical plan SBC.

5. What is the deadline for distributing the SBC? 

The insurer or employer must distribute the SBC at each of the following times:

  • At the beginning of each enrollment period (i.e., when a new employee first becomes eligible to enroll and at the start of each annual open enrollment period);
  • Within seven (7) business days of the participant’s request; and
  • Within 90 calendar days of a HIPAA special enrollment.


6. Do all eligible employees receive the SBC? What about dependents?

The SBC must be distributed to all plan participants including employees, retirees, and COBRA beneficiaries. Separate distribution for dependents is not required, unless the employer knows that they have a different address.

New hires (or employees newly eligible to enroll) must be given SBCs for all the plans for which they are eligible. At open enrollment, however, enrolled participants only need to receive the SBC for the plan in which they are currently enrolled, unless they request SBCs for other plans.

Also at open enrollment, it is not necessary to provide SBCs to employees who are eligible but not enrolled. Instead, they can be given a notice, such as a postcard, explaining that SBCs are available and how to request them. The Department of Labor (DOL) provides model language for this purpose that the employer may customize for its use:
Availability of Summary Health Information

“As an employee, the health benefits available to you represent a significant component of your compensation package. They also provide important protection for you and your family in the case of illness or injury. 

“Your plan offers a series of health coverage options. Choosing a health coverage option is an important decision. To help you make an informed choice, your plan makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about any health coverage option in a standard format, to help you compare across options.

“The SBC is available on the web at: http://www.website.com/SBC. A paper copy is also available, free of charge, by calling 1-XXX-XXX-XXXX (a toll-free number).”

7. Can the SBC be distributed electronically or are paper copies required? 

SBCs can be distributed electronically provided the method complies with the DOL safe harbor for electronic delivery of benefit notices. The usual DOL guideline is a little less strict for SBCs. For instance, if enrollment is conducted exclusively online, SBCs can be provided electronically. Otherwise, for enrolled participants who use a computer as part of their regular job duties, the SBC can be sent to that computer, or it can be posted and a notice sent explaining how to access it, along with information about how to request a paper copy at no charge. For eligible participants who are not enrolled, it is sufficient to post the SBCs online as long as persons are notified of availability (see model notice above). In any case, a paper copy must be furnished upon the participant’s request.

More Information 

For copies of the new templates, instructions, and related materials, see the following:

In summary, employers offering group health coverage are encouraged to work with their carriers and benefit advisors to ensure that SBCs are prepared and distributed according to the federal rules.

from ThinkHR

What are pay-per-use Health Insurance plans?

Level Funding

As health care costs continue to rise, level funding and self-funding are becoming a more and more attractive option for smaller companies. Technically speaking Benefit Administration Group uses level funded health insurance and insurance captives as the funding mechanisms for each pay-per-use health plan. In more simple terms, here is what that means for customers like you:

  1. Each plan has fixed monthly premiums and no change in monthly costs regardless of how many claims are incurred each month.
  2. Instead of your premium rates being determined by community rates set by your employees’ age and zip code, premium rates are determined by proper underwriting and the actual risk (demographics and health history) of your employees. This is accomplished through the use of a simple online health questionnaire and allows many companies to get far lower rates than they would otherwise from regular fully insured products.
  3. At the end of each year, if you incurred fewer claims than expected, your company gets a refund for the unused claims dollars.
  4. You have stop loss insurance fully baked into your plan rates so that if you incur more claims than expected during any given month, or throughout the year, you still never pay more than the fixed monthly premiums.
  5. If at any time you don’t like your plan, or you don’t like your renewal rates you can always leave and go back to your old carrier or a new one.

Ease the Annual Benefit Enrollment Uncertainty This Year

If you’re like most human resources practitioners, you face the annual benefits enrollment with a mixture of dread and anticipation each year. Dread for the expected price increases and anticipation for newer, less expensive and better plans that may be easier to administer and more valued by employees.

This year brings an added complication—uncertainty. With the Trump administration and Congress proposing significant changes in healthcare and tax reform and new twists being reported in the news every day, you and your employees undoubtedly have questions about what these proposals might mean for your insurance plans. New appointees to the federal regulatory agencies, such as the Occupational Safety and Health Commission, the National Labor Relations Board and the Equal Employment Opportunity Commission, to name a few, also have the potential to impact your safety and employment law risks.

Our advice? Get ahead of the game and start the planning early. Open discussions with your broker and begin to consider how to best ensure your employees get all the information they need in a format that works for them.

Be Prepared to Overcommunicate
Together with your broker and internal management teams, develop an employee communication strategy. Keeping in mind that employees are hearing and reading about health care reform, you’ll need to be prepared to help them separate the fact from the speculation. This year, anxiety could be playing a large role in your employees’ lives. In fact, a recent survey by Woman’s Day magazine found that 82 percent of respondents worry about finances, particularly the rising cost of healthcare, and 84 percent of women are concerned about the status of health care reform.

Understand the Power of a Strong Benefits Package
Properly designed, positioned, and communicated, the employee benefits package is one of the best tools in your arsenal to attract the right talent, enhance employee engagement, and retain the most valuable employees. Today’s employees expect more. In fact, according to a recent survey sponsored by Anthem Life Insurance Company, more than one in three millennial job applicants have turned down job offers with poor health insurance that didn’t meet their needs. Although millennials are the largest group in the workforce today, they are not alone in their expectations. The same survey found that 27 percent of those from other age brackets responded that they also declined job offers due to an employer’s lackluster benefits offer.

Other surveys are finding the same results relating not only with attracting new employees but also in retaining them. Employees today expect their employers to be creative, consider employee needs, make the benefits easy to use, and offer them choices to help manage their lifestyles. Besides health insurance, benefits protecting their incomes, such as disability insurance, financial planning and retirement benefits are important. In addition, consider that employees are tech savvy and expect to have online tools and calculators, along with complete communications, to assist them in making decisions regarding their insurance options.

Steps for Success
To prepare for this year’s enrollment, work with your broker early determine the best benefits packages and communications program. Make the most of marketing your benefits programs to employees by:

 

  1. Reviewing workforce demographics and benefits usage to get a better understanding of employees’ stages in the lifecycle. Knowing your audience and targeting benefits communications to meet those lifecycle needs makes the benefits more personal and relevant. Employees with young families, older workers preparing for retirement, empty nesters, and young singles all have distinctly different benefits needs and interests.
  2. Packaging benefits by target group and promoting messaging that speaks to that group’s needs while consistently reinforcing the overall benefits strategy and employer branding in the messaging. Different communications delivery systems may also be important to different employee groups.
  3. Starting the messaging with “why” the benefits are structured as they are and “what” the company’s overall benefits strategy is designed to accomplish for employees. Most employees are smart, so don’t sugarcoat any bad news about changes in the benefits program. This is a good time to highlight the important value of their benefits programs, promote wellness, encourage retirement savings, and incent cost-effective usage of benefits programs.
  4. Being ready to address the questions triggered by the federal and state proposals to change tax and benefits rules. Clear the misconceptions and incomplete information and focus on how the benefits package has been designed to comply with the current laws in place.
  5. Keeping the messaging straightforward. Provide clear information, checklists, and decision support tools that are easy to follow. Have the details available but keep the key messages and “what you need to do for enrollment” information central to the enrollment materials.
  6. Bringing company managers and supervisors into the discussions prior to launch. Give them a heads up regarding the upcoming benefits changes and enlist their help in the process.
  7. Tackling the “how” of the benefits communications program, including:
  1. Communications delivery methods. With the variety of mediums available, the world is your oyster. Consider electronic communication, mobile apps, webinars, in-person company meetings, text messages, direct mail home to involve the entire family, social media, or even a live hotline for questions.
  2. Enrollment methods. Will enrollment be online? Manual? Mobile? Make it as administratively simple as possible for employees. Use electronic tools if the budget allows.
  3. Timing. Establish a timeline working backwards from the date that the information must be completed then work forward to deliver the communications program.
  4. Frequency. Employees need time to consider their options and allow the information to soak in. Consider sending employee prompts and reminders so that the enrollment process is completed in a timely manner.

The annual open enrollment communications opportunity is precious—you can influence how employees see benefits or cost changes, alleviate any fears about federal and state benefits or tax law changes that are still being considered by lawmakers and regulators, motivate employees to change their health or savings habits, and let employees know that management is listening, considering their feedback valuable, and responding to their needs.

SPD, Plan Document, Certificate of Insurance – Do You Have What You Need?

business-documents

A summary plan description (SPD) is the primary vehicle for informing participants and beneficiaries about their plan and how it operates. It must:

  • Be written for the average participant and be sufficiently comprehensive to apprise covered persons of their benefits, rights, and obligations under the plan; and
  • Accurately reflect the plan’s contents as of the date not earlier than 120 days prior to the date the SPD is disclosed.

SPDs are to be distributed automatically to participants within 90 days of becoming covered by the plan and to pension plan beneficiaries within 90 days after first receiving benefits. However, a plan has 120 days after becoming subject to the Employee Retirement Income Security Act (ERISA) to distribute the SPD. An updated SPD must be furnished every five years if changes are made to SPD information or the plan is amended — otherwise the SPD must be furnished every 10 years.

Plan documents are all documents related to plan, including the SPD. The plan administrator must furnish copies of certain documents upon written request and must have copies available for examination. These documents include the latest updated SPD, latest Form 5500, trust agreement, and other instruments under which the plan is established or operated. Copies must be furnished no later than 30 days after a written request. The plan administrator must make copies available at its principal office and certain other locations.

Evidence of coverage (EOC) is further information regarding the plan that details coverage for the plan period. Each insurance carrier will have an EOC booklet, also called a schedule of benefits. These documents are often called certificates of insurance. This EOC/schedule of benefits does not meet the SPD requirements under ERISA. The EOC explains the health benefits participants and their dependents have under the plan. It details the services that will and will not be covered and the actions employees must to take to receive the health benefits — such as paying a co-pay, meeting a deductible, or using particular health care providers. The EOC can also refer to a certificate or contract provided to a health plan member that contains information about coverage and other rights.

ERISA requires the plan sponsor (employer) to provide an SPD to all plan participants. The SPD may incorporate the carrier’s EOC by reference, which generally provides sufficient description of the plan’s benefits. However, the SPD also must include specific content, such as ERISA plan number, Employer Identification Number (EIN), plan financing method, and other information that would not be found in a carrier EOC. Many employers choose to do an SPD wrap, which incorporates all benefits in one document instead of having a separate one for each line of coverage.

According to the Department of Labor’s Final Rules Relating to Use of Electronic Communication and Recordkeeping Technologies by Employee Pension and Welfare Benefit Plans; Final Rule, you can distribute insurance certificates and various ERISA required plan documents electronically via a company website. The department allows electronic notification and distribution of documents by email, attachment to an email, or by posting documents on a company website. However, just placing the documents on a company website does not, by itself, satisfy ERISA’s disclosure requirements.

Under ERISA, the rules allow for electronic delivery of all documents that must be furnished or made available to participant and beneficiaries. This includes SPDs, summary annual reports, individual benefit statements, and investment-related information for participant-directed accounts. These rules are limited to disclosures that plans are required to make to participants and beneficiaries under ERISA.

Prior to implementing, a plan administrator must notify all participants and beneficiaries of the availability of the particular disclosure document by sending written or electronic notice that directs them to the document on the website.

Top Questions on Form 5500 Preparation

Reprinted from ThinkHR

Man with Note Pad and FAQs ConceptsAt this time of year, many employers and benefit advisors begin preparing Form 5500, the annual report required for most employee benefit plans. Form 5500 must be filed with the federal government within seven months of the end of the plan year. For calendar-year plans, that means the plan’s 2016 Form 5500 is due July 31, 2017.

The following are frequently asked questions about Form 5500 for employer-sponsored health and welfare plans.

Frequently Asked Questions

Is Form 5500 required for our plan?

Under the Employee Retirement Income Security Act of 1974 (ERISA), Form 5500 must be filed annually for employer-sponsored welfare plans with 100 or more participants as of the beginning of the plan year. To count the number of participants, include covered employees, retirees, and primary COBRA beneficiaries, but do not include dependents.

Welfare plans include plans for medical, dental, vision, life, accident, and disability benefits, as well as health flexible spending accounts (HFSAs) and health reimbursement arrangements (HRAs). If the plan includes group insurance coverage, information about the insurance policy must be reported on Schedule A as part of the Form 5500 filing.

Most welfare plans are unfunded, which means all benefits are paid through group insurance contracts, or directly from the employer’s general assets, or a combination of both. In that case, the filing will be comprised of the three-page Form 5500 only, or the Form 5500 with one or more Schedules A if the plan includes group insurance coverages. No other schedules apply.

On the other hand, if the plan is funded (e.g., a benefits trust), or part of a multiple employer welfare arrangement (MEWA), Form 5500 may be required whether or not there are at least 100 participants. Additional schedules also may be required. Funded plans and MEWAs are uncommon and outside the scope of this article.

The following plans are exempt from ERISA; therefore, Form 5500 does not apply:

  • Plans sponsored by governmental employers and certain church plans;
  • Most voluntary plans (e.g., employee-pay-all after-tax insurance plans without any employer sponsorship or contribution);
  • Payroll practices (e.g., unfunded vacation and sick pay); and
  • Plans maintained solely to comply with state workers’ compensation, unemployment, and weekly disability insurance laws, without providing additional benefits.

When is Form 5500 due and how is it filed?

Form 5500 and any required schedules must be filed electronically using the Department of Labor (DOL) EFAST2 electronic filing system. Paper filings are no longer accepted. To prepare and file the form and any schedules, you may use approved third-party vendor software or the DOL’s web-based filing system IFILE.

Filing is due within seven months after the end of the plan year. For instance, for calendar-year plans, the due date is July 31 of the following year (or the next business day if July 31 falls on Saturday or Sunday).

The due date can be extended by two and one-half months if the employer mails a simple Form 5558 Application for Extension of Time, no later than the original due date. (Instructions for U.S. mail or overnight delivery are included with the form.) In very rare cases, the IRS denies the request. Normally, the IRS does not respond which means the extension is automatically granted. Later on, when filing Form 5500, be sure to check the appropriate box in Part I, D, to indicate that the due date was extended by filing Form 5558.

We have one plan covering employees at our parent company and two subsidiaries. In Part I, A, of Form 5500, do we check the box as a “single” or “multiple” employer?

A plan sponsored by multiple entities that belong to the same controlled group is deemed a single-employer plan. A controlled group means two or more related employers that are under some degree of common ownership or control, such as parent and subsidiary companies, or brother-sister companies. (The IRS definition of controlled group is used for a variety of business and tax purposes, so the group’s tax advisor or financial officer will be familiar with the definition and can confirm the group’s status.) Use the Employer Identification Number (EIN) as shown in the plan document and SPD; this usually is the parent company’s EIN.

For reference, here are quick definitions for the boxes in Part I, A, of Form 5500 (check one):

  • A “single employer plan” is an ERISA plan that is sponsored by a single employer, or by multiple entities that belong to the same controlled group and, therefore, are deemed a single employer.
  • A “multiemployer plan” is an ERISA plan that is sponsored by unrelated employers and a labor union (e.g., Taft-Hartley plan or union trust plan).
  • A “multiple-employer plan” is an ERISA plan that is sponsored by unrelated employers (that is, the entities do not belong to the same controlled group). If the plan is a welfare plan, it also is called a multiple employer welfare arrangement (MEWA). This is uncommon. In some states, state insurance laws prohibit MEWAs.
  • A “direct filing entity” or DFE is usually a bank or trust that files a Form 5500 listing all the plans that are invested in the master trust (e.g., pension plan investments).

Employers and benefit advisors that prepare Forms 5500 for welfare plans usually are reporting a “single employer plan.” Employers are unlikely to handle any of the other three types of plans shown above; those plans and forms generally are handled by trustees.

Part II of Form 5500 asks for basic plan information. Where do we find this information?

Although Form 5500 is prepared and filed many months after the end of the plan year, the plan’s name, plan number, and plan year were designated by the employer when the plan was first established.

ERISA requires that the plan sponsor (employer) set forth the plan in writing and provide a summary plan description (SPD) to plan participants. Those materials must specify the ERISA plan name, plan number, and plan year, along with the plan sponsor’s EIN and other required information. Therefore, the information needed to complete Part II of Form 5500 will be found in the plan document and SPD.

Part II asks for information about who prepared the form. Is this required?

No. Do not provide information about the preparer. Although the IRS added space for the preparer’s information, officials later announced that it should not be provided. Specifically, the IRS issued the following instruction: “The IRS has decided not to require plan sponsors to enter the “Preparer’s information” at the bottom of the first page of Form 5500 for the 2016 plan year and plan sponsors should skip these questions when completing the form.”

Part III, line 8, asks for codes. What are the correct codes?

For a welfare plan, do not enter any codes on line 8a. Refer to page 20 in Instructions for 2016 Form 5500 for the index of Plan Characteristic Codes, then enter the appropriate code(s) on line 8b. Codes for welfare benefits, including health plans and group life and disability insurance, begin with “4.”

For instance, if Form 5500 is for a welfare plan comprised solely of two medical plans (PPO and HMO), an HFSA, and an HRA, the appropriate code would be 4A (health, other than vision or dental). If the plan also included dental, life insurance, and AD&D, the appropriate codes would be 4A, 4B, 4D and 4L.

Part III, lines 9a and 9b, ask about funding arrangements and benefit arrangements. Please explain.

On both lines, check the box for “Insurance” if the plan includes coverages provided through one or more group insurance policies (e.g., group life, medical, STD, LTD). Check the box for “General assets of the sponsor” if the plan includes any self-funded or uninsured coverages (e.g., HFSA, HRA, or other self-funded health plan). Many employers offer insured plans along with an HFSA, in which case both boxes will be checked.
Do not check the boxes for 412(e)(3) contracts or trusts; these are uncommon arrangements requiring tax professionals or plan trustees to prepare the form.

When is Schedule A required?

Schedule A must be filed with Form 5500 if any plan coverages are provided through group insurance contracts. In that case, the insurance company will provide the employer with information about the policy, and information about any commissions or fees, for use in preparing the schedule. Carriers are required to provide this information within 120 days after the end of the plan year. If the plan includes multiple group policies, such as separate policies for group life, PPO medical, HMO medical, dental, and vision, there will be a separate Schedule A for each one.

The group policy year usually is the same as the ERISA plan year, although that is not required so different dates may apply. Include Schedule A with policy information for the policy year that ends within the plan year. For instance, if the ERISA plan year is January 1 and the group policy year and renewal date is July 1, the 2016 Form 5500 will be filed for period January 1, 2016 through December 31, 2016 and include Schedule(s) A for the policy year July 1, 2015 through June 30, 2016.

Is Schedule C required?

Schedule C does not apply to unfunded welfare plans, which are the vast majority of welfare plans. Unfunded means that all plan benefits are paid through group insurance contracts, or directly from the employer’s general assets, or a combination of both. Self-funded health plans are unfunded plans, despite the somewhat confusing terms, as long as benefits are paid from general assets, which usually is the case. Although fees may be paid to consultants, advisors, and other service providers, expenses paid from general assets or in connection with a § 125 plan are not reported on Schedule C.

Schedule C is required only for certain large welfare plans that are funded through benefit trusts (e.g., a voluntary employees’ beneficiary association (VEBA) or union trust), which is uncommon. In that case, Form 5500 and all required schedules should be prepared by tax professionals or plan trustees.

More Information
See the following links for a sample Form 5500 for plan year 2016, instructions for completing the form, and helpful tips from the DOL:

Remember, the actual filing must be completed electronically using the DOL’s EFAST system. Paper filings are not accepted. Lastly, if you are unable to file Form 5500 on time, complete, print, and mail Form 5558, Application for Extension of Time, for an automatic two and one-half month extension. Form 5558 must be mailed no later than the original due date for Form 5500.