Wrap Plan Documents – The New Fundamental ACA Compliance Tool

Reasons for an Employer to create a Wrap Plan Document and Distribute an SPD  Required by ERISA  Combines several benefit offerings into one plan for 5500 filing or other purposes  Allows employer to define elements that are often inconsistent or missing in certificates issued by insurance carriers  Allows employer to create plan features that the carrier will not document in insurance certificate ACA has made them more important than ever!!

Required by ERISARequired by ERISA  Required by ERISA for ALL plans  Regardless of size or funding  But not plans that are exempt from ERISA – church and governmental plans  Informs participants and beneficiaries about their benefits, rights, and obligations under the Plan  ERISA requires that the plan documents include specific information  Statement of Rights  Plan Sponsor Name  Plan funding information

Required by ERISARequired by ERISA  Distribution Requirements for SPD  Within 120 days of implementing new group health plan  Within 90 days of enrollment in plan  Within 210 days following the last day of the 5 th plan year if SMM  Within 210 days following the last day of the 10 th year if no SMM Plan document must be provided within 30 days of a request  Penalties  Up to $110 per day for failure to provide  Failure to have one does not invalidate the plan  Bigger concern is when documents issued do not accurately reflect the plan’s intent

Combine Several Benefit Options into One Plan  If subject to 5500 filing requirements, will allow employer to file only one 5500 (and will reduce penalties if filing is late or missed)  HRA/Medical Plan or Wellness/Medical Plan – Employer will want to have these plans combined so that you can limit COBRA on the HRA or wellness to those who elect COBRA on medical.  If the plans are separate, then participants have to be given a separate COBRA election

Create Consistent Plan Features and Add missing ones  Eligibility  Medical carriers often will not customize  ACA waiting period and eligibility details  Leave provisions – each insurer or administrator will define based on their own templates and preferences  Effective date and termination of employee and dependent coverage  Usually not consistent from carrier to carrier  Plan year  Not included in most carrier certificates  Needed to determine compliance date for most ACA requirements

Design Plan FeaturesDesign Plan Features  Expand eligibility (with permission of carrier when insured or stop loss carrier if self-funded)  Limit eligibility  Spousal exclusion (and/or dependent)  Change wording to exclude those that do not comply with eligibility audit  Include wellness plan requirements  Add benefits or exclusions (with permission of carrier)

ACA  Increase in DOL Audits  Increase in provider initiated claims appeals  More items that need to be documented  Waiting periods  Eligibility  Notices

Polestar Benefits, Inc. 412 Jefferson Parkway, Suite 202 Lake Oswego, OR (855) com 9 Questions? Comments?Questions? Comments? We are happy to help!We are happy to help!