Enhancing Compliance Delivery- Dan Bond, Principal, Compliancedashboard, LLC

Annual

Weekly

Monthly

Employers Need a Process to Cope with

Compliance ChangesDaily

Compliance Changes

Compliance Changes

Compliance Changes

Opportunities

* ADP Research InstituteSM. (2012). ADP Survey Finds Health Care Reform and Increasing Compliance Complexity May Drive Outsourcing of Benefits Administration [Press Release]. Retrieved from http://www.adp.com/media/press-releases.aspx

Too difficult/complex to handle

Lack of internal resources/staff

Complexity of health care reform

Reduce admin burden of staff

Access to knowledge/expertise

Ensure compliance

32%

33%

34%

43%

50%

54%

20%

33%

29%

50%

41%

49%

Large Midsize

Reasons for Outsourcing Benefits Administration

Opportunities

2014 Compliance CostPlan Admin/Fiduciary Liability•ERISA Title I

Prepare/Distribute Notices• Summary of Benefits and Coverage• Summary Annual Report• Women’s Health and Cancer Rights Act Notice• Children’s Health Insurance Program Notice• HIPAA Preex Condition Exclusion Notice• HIPAA Certificates of Creditable Coverage• HIPAA Notice of Privacy Practices• HIPAA Preex Condition Exclusion Notice• HIPAA Special Enrollment Notice• Medicare Part D Creditable Coverage Notice• Notice of the Health Benefit Exchange• Patient Protections Disclosure• USERRA Rights Notice Reporting & Disclosure

Prepare Disclosure Language/Materials• Qualified Medical Child Support Orders• Newborns’ Protection Act• HIPAA Nondiscrimination• Grandfathered Plan Status

 

Audit Plan Provisions• Recordkeeping Requirements• Mental Health Parity Act• Subrogation• Claim Procedures• Prohibition of preexisting condition exclusions for enrollee’s under 19• Prohibition of annual and lifetime dollar limits

Prepare Disclosure Language & Materials• Qualified Medical Child Support Orders• Newborns’ and Mothers’ Health Protection Act• HIPAA Nondiscrimination• Grandfathered Plan Status

 Prepare Forms/Report to Government• Form 5500• Creditable Coverage to CMS• W-2 Reporting

Prepare/Distribute Plan Documents• Plan• Summary Plan Description• Summary of Material Modifications• Cafeteria Plan

Research and Education• Working Families Tax Relief Act• FMLA Continuation of Coverage• On-Site Clinic ERISA Compliance• ERISA Safe Harbor Delivery Methods• Employee and Dependent Eligibility Requirements• Nondiscrimination Rules (beyond HIPAA)• Maintaining Grandfathered Plan Status Disclosure

COBRA• Administration and monitoring• Participant tracking• Eligibility compliance• Send/document notices

 HIPAA Privacy & Security• Implement/Review policies and procedures• Risk assessment/breach notification procedures• Implement/Review administrative, technical and physical safeguards• Audit plan documentation• Workforce training

Bonding Requirements• Every person who handles plan assets

Employer Roles

Legal Responsibilities

FiduciaryPlan

Administrator

ERISA

Over Reliance On:

• Insurance Company

• TPA

• COBRA Administrator

Compliance Gaps

Perception of responsibility

Compliance Gaps

Does not match actual legal obligations

Empl

oyee

Issu

es

Law

suits

Aud

its

Doc

umen

tatio

n

Gaps inevitably

result

Compliance Gaps

Where To Start?

“Gov’t agencies will

redouble efforts for

reviewing internal

controls in order to

facilitate compliance”

Compliance Process

• Call to Action

• Progress Tracking

• Audit Reports

Compliance Engagement

Turnkey System

• You Determine Involvement

• Reduce Workload

• Web Based: Easy Updates

Compliance Engagement

Customized Calendar

• Plan Year

• Employer Type/Size

• Plan Type and Coverages

Compliance Engagement

1

2 3

Best Practices

Engage Your Practice

Engage Your Clients

Stay Engaged

• Point Person (Champion)

• Training Plano Account Managerso Producers

• Incorporate in Renewals/Proposals

Let Us Help!!!

Best Practices

1 Engage Your Practice

• Educate

• Develop Rollout Plano Phaseso By Account Managero By Producer

Let Us Help!!!

Best Practices

2 Engage Your Clients

• Compliance Reports

• Compliance Blogs

• Compliance Updates

Let Us Help!!!

Best Practices

3 Stay Engaged

Engage Clients

Tactics

Tactics

Eligibility

Unique Opportunity to Coordinate Plans

Practices & Policies ≠ Contracts & Plan Documents

Clearly Define Participants

Monitor and Enforce Rules

Tactics

Documentation

Who is Preparing Your Clients Documentation?

Documentation Rules the Plan

Health Certificate ≠ SPD

Fill the Documentation Gaps

Tactics

Reporting

Form 5500: Identify ERISA Plans

Identify Roles for Notice Distribution

Identify Roles for Plan Disclosures

Electronic Distribution

Tactics

Health Care Reform

Transitional Reinsurance Fee

Section 6055 & 6056 Reporting

Shared Responsibility Payments

Health Plan Identifiers

Tactics

HIPAA Privacy

Final Rule

Privacy Breach

Business Associate Agreements

Privacy Notice

ERISA Penalties (DOL)

Failure to Furnish DocumentsFor Example: SPDs, SMMs, documentation, Form 5500 or Summary Annual Report (SAR)

Penalty• $110 per day per occurrence after the 30th day of request

Liability• Plan Administrator• Document failures frequently precede lawsuits

o Eligibility, denied claims, lost benefits

ERISA Penalties (DOL)

Failure to Timely File a Form 5500ERISA Plans with 100 or more employee participants at the beginning of the plan year

Penalty• $1,100 per failure per day

Liability• Plan Administrator

Identify ERISA Plans!!

HIPAA Portability & Nondiscrimination (IRS)

Violation of HIPAAFor Example: GINA, Women’s Health and Cancer Rights Act, Mental Health Parity

Penalty• $100 per participant per day during noncompliance

(Form 8928)

Liability• Employer

o Does not apply to Gov’t plans (but possible enforcement by HHS)

HIPAA Privacy/Security/EDI (HHS)

Penalties Scaled Based on Knowledge

Penalty

• $100 - $50,000 per violationo Would not have known with due diligence

• $1,000 - $50,000o Reasonable cause – not willful neglect

• $10,000 - $50,000o Willful neglect – but corrected

• $50,000+o Willful neglect and not corrected

Liability

• Covered entities and business associates

COBRA Penalties (IRS)

COBRA FailureFor Example: timely provide required notices, charge appropriate premiums and provide required levels of coverage

Penalty• $110 per beneficiary per day

Liability• Plan Administrator• COBRA Administrator (if provides benefits and is

responsible under written agreement)

ACA (DOL, HHS, IRS)

ACA FailureACA’s market reforms for health care reform

Penalty• $100 per participant per day during

noncompliance (Form 8928)

Liability• Plan Sponsor• Insurer

ACA (DOL)

SBC FailureTimely distribute a Summary of Benefits and Coverage

Penalty• $1,000 per failure per participant

Liability• Plan Administrator• Fully insured plans may contract with insurance

company

ACA (IRS)

W-2 Reporting FailuresAggregate cost of applicable employersponsored coverage on an employee’s W-2 (250+ W-2s in the preceding calendar year)

Penalty• $50 per statement (same penalty as not

providing a W-2)

Liability• Employer

ACA (IRS)

PCORI Fee FailuresFiled with employer’s Form 720

Penalty• Same penalty as not providing a Form 720

(100% of unpaid tax)

Liability• Employer (sponsor of self-insured plan). Insurer

responsible for PCORI fees under a fully insured arrangement.

DEMO

Advantages

Differentiate Your Service

• Client Retention Tool

• Prospecting Tool

Advantages

Product Markup or Resale

• Additional Income Source

• Fee Based Consulting

Advantages

Information Resource

• Increase Product Knowledge

• Health Care Reform Consulting

Questions

Thank You!