2018 EMPLOYEE WELFARE BENEFIT COMPLIANCE CALENDAR

 

Ongoing Obligations

ITEM RECIPIENT WHEN FORMS PENALTIES
Plan Documents Participants & beneficiaries Within 30 days of request Review of Plan Documents (Premium Content) Failure to provide upon request: $147/day; maximum of $1,472 per request.,$1,087 penalty for willful failure to provide.
Wrap Summary Plan Description (SPD) Participants To participants within 90 days of start of coverage. Updated SPD every 5 years if changes made to SPD or if plan amended; every 10 years if no changes made. Legally Prepared Summary Plan Description (Premium Content) Failure to provide upon request: $147/day; maximum of $1,472 per request. $1,087 penalty for willful failure to provide.
Summary of Material Modifications (SMM) Participants Not later than 210 days after end of plan year in which changes are adopted (7/30/2018 for calendar year plans) Summary of Material Modifications Template (Premium Content) Will call into question validity of reduction and possible exposure to provide the same benefits before modification.
Summary of Material Reduction in Covered Services or Benefits Participants Within 60 days of adoption of material reduction in plan services or benefits Summary of Material Reduction in Covered Services or Benefits (Premium Content) Will call into question validity of reduction and possible exposure to provide the same benefits before reduction.
Notice of HIPAA Special Enrollment Rights All employees eligible to enroll in group health plan At or before time employee is offered opportunity to enroll in group health plan. HIPAA Special Enrollment Notice (Premium Content) Must allow employee to enroll.
Medical Child Support Order Notice (MCSO) Participants, any child named in a MCSO, and the child's representative Promptly upon receipt of notice Handled by plan administrator
National Medical Support Notice (NMS) State agencies, participants, custodial parents,
children, representatives
Part A: Within 20 days of notice or sooner, if reasonable. Part B: Within 40 days of receipt or sooner, if reasonable Handled by plan administrator
Grandfathered Plan Disclosure Included with any plan materials describing benefits or health coverage Grandfather Plan Notice (Premium Content) Plan loses its grandfathered status.
Summary of Benefits & Coverage (SBC) & Uniform Glossary Participants & beneficiaries Within 7 days of request
SBC Notice of Modification Participants & beneficiaries Notice must be provided no later than 60 days prior to the date on which the modification will become effective Summary of Benefits and Coverage Notice Modification (Premium Content)
Employer Notice to Employees of Coverage Options (Exchange Notice) All employees Provide to all new employees Employer Notice to Employees Coverage Options Exchange Notice (Premium Content)
Wellness Programs Notice All possible participants Before providing any health information, and with enough time to decide whether to participate in the program Wellness Program Notice (Premium Content)
Notice of Alternative Wellness Program Standard All possible participants In all materials that describe the wellness program. Notice of Alternative Wellness Program Standard (Premium Content)
Notice of Rescission of Coverage Participant affected At least 30 days before rescission occurs Rescission will be ineffective
HIPAA Privacy Notice Participants Every 3 years HIPAA Notice of Privacy Practice (Premium Content) Fine from HHS
COBRA
Initial COBRA Notice Covered employees & spouses When group coverage starts COBRA General Notice DOL penalties and IRS excise tax.
COBRA Election Notice Covered employees, spouses, and other qualified beneficiaries No later than 14 days after the COBRA qualifying event COBRA Election Notice Extension of time for employee to exercise COBRA with employer paying for benefits in the interim.
Notice of Unavailability of COBRA Individual who claim to be qualified for COBRA but are not Within 14 days of being notified of qualifying event Provided by TPA
Notice of Early Termination of COBRA Qualified beneficiaries whose COBRA coverage will terminate prior to the maximum COBRA coverage date As soon as practicable after it is determined that coverage will terminate
Notice to Plan Administrator Plan Administrator Within 30 days of qualifying event
Notice of Insufficient Payment COBRA participant After receipt of insufficient payment
Premium Change Notice COBRA participant At least one month prior to effective date of premium change
Mental Health Parity & Addiction Equity Act (MHPEA)
Criteria for Medically Necessary Determination Notice Any current or potential participant, beneficiary, or contracting provide Upon Request
Claims Denial Notice Participants and Beneficiaries Upon request or as otherwise required by law
Increased Cost Exemption Participants, beneficiaries, EBSA, state regulators If using cost exemption
 

ANNUAL OBLIGATIONS

ITEM RECIPIENT WHEN FORMS PENALTIES
CHIPRA Notice All employees Annually CHIPRA Notice $112/day for each employee that was not provided the
notice
Women's Health and Cancer Rights Act Notices (WCHRA) Participants Annually (also upon enrollment) WHCRA Annual Notice
WHCRA Enrollment Notice
Form 5500 filing Participants 7/31/2018 for calendar year plans (or within 7 months of end of plan year for non-calendar year plans) For employers with 100 or more participants at start of plan year 5500 Prepared by myTAXcounsel™
5500 Prepared by myTAXCounsel™ (Premium Content)
Max penalty of $2,097/day
Summary Annual Report (SAR) Participants Within later of 9 mos after end of plan year or 2 mos after filing of Form 5500 (9/28/2018 if no extension filed for 5500) Prepare Summary Annual Report (Premium Content)
W-2 Reporting Employee participants Due to employees by 1/31/2018
Form 1095-C Tax year 2017 forms due to employees by 1/31/2018 ACA requirement
Form 1094-C For tax year 2017 forms: 2/28/2018 if filing by paper or 4/2/2018 if filing electronically ACA requirement
Wellness Notices Participants 12/31/2018 for calendar year plans (or no later than first day of plan year for non-calendar year plans) Wellness Program (Premium Content)
Notice of Alternative Wellness Program Standard (Premium Content)
Patient Protection Provider Choice Notice Participants 12/31/2018 for calendar year plans (or no later than first day of plan year for non-calendar year plans) Patient Protection Provider Choice Notice
Medicare Part D Creditable Coverage Notice Before October 15th (annual coordinated election
period start date)
Medicare Part D Creditable Coverage Disclosure Notice
Medicare Part D Disclosure to CMS March 1st (or within 60 days of start of plan year if
a non-calendar year plan)
Medicare Part D Disclosure to CMS Form
Medicare Part D Retiree Drug Subsidy Reconciliation 3/3/2018 (or 15 months after end of plan year for non-calendar year plans) Medicare Part D Retiree Drug Subsidiary Reconciliation
Medicare Part D Retiree Drug Subsidy Application and Retiree List 10/3/2018 for Calendar Year plans (or 90 days before the beginning of the plan year) Medicare Part D Retiree Drug Subsidiary Retiree List Form
M1 Filing 1-Mar Form M-1 $1,527/day
Comparative Effectiveness Research Fee (CERF) aka PCORI fees IRS (on form 720) 7/31/2018 PCORI Form 720
 

UPON ENROLLMENT

ITEM RECIPIENT WHEN FORMS PENALTIES
Women's Health and Cancer Rights Act Notices (WCHRA) Participants Upon enrollment, (also annually) WHCRA Enrollment Notice
Summary of Benefits and Coverage (SBC) and Uniform
Glossary
Participants and beneficiaries Upon enrollment, renewal, and reissuance of coverage Summary of Benefits and Coverage Template
Summary of Benefits and Coverage Uniform Glossary
Failure
to provide: $1,105 per participant
HIPAA Privacy Notice Participants Upon enrolment (and every 3 years) HIPAA Notice of Privacy Practices

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