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

Annual Weekly Monthly Employers Need a Process to Cope with Compliance Changes Daily Compliance Changes Opportunities

* ADP Research Institute SM. (2012). ADP Survey Finds Health Care Reform and Increasing Compliance Complexity May Drive Outsourcing of Benefits Administration [Press Release]. Retrieved from Reasons for Outsourcing Benefits Administration Opportunities

2014 Compliance Cost Plan 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 Fiduciary Plan Administrator ERISA

Over Reliance On: Insurance Company TPA COBRA Administrator Compliance Gaps

Perception of responsibility Compliance Gaps Does not match actual legal obligations

Employee Issues Lawsuits Audits Documentation 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 Plan o Account Managers o Producers Incorporate in Renewals/Proposals Let Us Help!!! Best Practices 1Engage Your Practice

Educate Develop Rollout Plan o Phases o By Account Manager o By Producer Let Us Help!!! Best Practices 2Engage Your Clients

Compliance Reports Compliance Blogs Compliance Updates Let Us Help!!! Best Practices 3Stay Engaged

Engage Clients 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 Documents For Example: SPDs, SMMs, documentation, Form 5500 or Summary Annual Report (SAR) Penalty $110 per day per occurrence after the 30 th 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 5500 ERISA 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 HIPAA For 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 violation o Would not have known with due diligence $1,000 - $50,000 o Reasonable cause – not willful neglect $10,000 - $50,000 o Willful neglect – but corrected $50,000+ o Willful neglect and not corrected Liability Covered entities and business associates

COBRA Penalties (IRS) COBRA Failure For 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 Failure ACA’s market reforms for health care reform Penalty $100 per participant per day during noncompliance (Form 8928) Liability Plan Sponsor Insurer

ACA (DOL) SBC Failure Timely 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 Failures Aggregate cost of applicable employer sponsored 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 Failures Filed 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

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