U.S. Department of Labor Employee Benefits Security Administration (EBSA) Pension & Health Plan Options for Small Business Owners.
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U.S. Department of Labor Employee Benefits Security Administration (EBSA)
Pension & Health Plan Options for Small Business Owners
Employee Benefits Security Administration
Enforcement
Perform audits or investigations to ensure that plan is operating within the provisions of Title I of ERISA
Employee Benefits Security Administration
Technical Benefit Advisors
Advocates for the law
Advise of rights and responsibilities IAW title I of ERISA
Provide guidance to employers regarding compliance issues
Employee Benefits Security Administration (EBSA)
EBSA’s mission is to deter and correct
violations of the relevant statutes
Employee Benefits Security Administration (EBSA) Develop policies and laws
that simplify compliance, and encourage the growth and
preservation of employment-based benefits
Employee Benefits Security Administration (EBSA) Assist plan officials in
understanding the requirements of relevant statutes in order to meet their legal obligations
Relevant Statutes
Title I, The Employee Retirement Income
Security Act of 1974 (ERISA)
ERISA
Title I, The Department of Labor, EBSA
Title II, The Department of Justice, IRS
Title III, The Department of Justice, IRS
Title IV, Pension Benefits Guarantee Corporation
ERISA - Title I
Fiduciary Duties
Reporting & Disclosure
Participant Contributions
Amended Health Care Legislation
Consolidated Omnibus Budget Reconciliation Act (COBRA)
Health Insurance Portability and Accountability Act (HIPAA)
Newborns’ and Mothers’ Health Protection Act
Women’s Health and Cancer Rights Act (WHCRA)
Mental Health Parity Act
COBRA
Continuation of health care coverage at group health rates
COBRA Eligible Employers: must employ > 20 FT employees for > 50% of the previous calendar operational year;
offer a health care plan
NEW COBRA PREMIUM ASSISTANCE PROGRAM
The American Recovery and Reinvestment Act of 2009 (ARRA)provides premium assistance and expanded eligibility for health benefits under COBRA
Health Insurance Portability and Accountability Act (HIPAA)
Limitations of Pre-existing Condition Exclusions
Special Enrollment Rights
Nondiscrimination Rules (health related)
Guaranteed Coverage (post COBRA, etc.)
HIPAA Privacy Rules
NOT DOL
Governed by the Department of Health and Human Services, Office of Civil Rights
http://www.hhs.gov/ocr/hipaa/privacy.html
Effective 14 April 2003
Newborns’ and Mothers’ Health Protection Act
If group health plan offers coverage:
Prevents “drive through” birthsEntitles 48 hour hospital stay following a regular deliveryEntitles 96 hour hospital stay following a Caesarian sectionDecision to invoke entitlements is made by the mother in consultation with her attending physician
Women’s Health and Cancer Rights Act (WHCRA)
If group health plan offers coverage:
Guarantees reconstruction on the breast on which the surgery was performedGuarantees reconstruction on the other breast to product a symmetrical appearanceGuarantees subsequent coverage of ANY complication resulting from the mastectomy, to include lymphodemaSpecial annual notice requirements regarding coverage
Mental Health Parity Act
To provide parity between mental and medical health benefits
If plan offers coverage:Provides identical $$ amount ceiling between mental and medical health benefits
CHIP REAUTHORIZATIONChildren’s Health Insurance Program Reauthorization Act of 2009 Effective April 1, 2009
EBSA Compliance Assistancewww.dol.gov/ebsa
Assistance for Health Plans
Assistance for Retirement Plans
General Fiduciary Assistance
Retirement Solutions for Small Employers
Health Plan Assistancewww.dol.gov/ebsa
1. Benefit Claims Procedure Regulation FAQs2. Health Benefits Under COBRA3. COBRA Continuation Health Coverage FAQs4. Notice of Changes under HIPAA to COBRA Continuation
Coverage under Group Health Plans5. Compliance Assistance for Group Health Plans – HIPAA and
Other Recent Health Care Laws6. HIPAA Nondiscrimination Requirements FAQs7. Recent Changes in Health Care Law8. Multiple Employer Welfare Arrangements Under ERISA
(MEWA)9. Women’s Health and Cancer Rights Act of 1998
Retirement Plan Assistancewww.dol.gov/ebsa
1. A Look at 401(k) Plan Fees for Employers2. 401(k) Plan Fees Disclosure Tool3. Pension Plans, ERISA, and EFAST 5500 FAQs4. Cash Balance Pension Plans Frequently Asked
Questions5. Qualified Domestic Relations Order (QDRO) –
An Overview6. Determining Qualified Status and Paying
Benefits
General Fiduciary Assistancewww.dol.gov/ebsa
1.Voluntary Fiduciary Correction Program (VFCP)
2.VFCP FAQs
3.ERISA Advisory Opinion and Information Letters
Retirement Solutions - Small Employers www.dol.gov/ebsa
1.Simplified Employee Pensions (SEPs)2.Savings Incentive Match Plan for
Employees of Small Employers (SIMPLEs)3.Easy Retirement Solutions for Small
Business4.Small Business Retirement Savings
Program/Employer-Employee Advisor5.Select a Retirement Plan
Select A Retirement Plan
SEP IRA
Payroll Deduction IRA
Simple IRA
401(k)
Profit Sharing
Defined Benefit
Time limits for deciding group health claims
Type of Claim Initial AppealUrgent care 72 hrs 72 hrsPre-service 15 days* 30 daysPost-service 30 days* 60 days
* 15-day extension availableSpecial rules for “concurrent care”
EBSA Contact Informationwww.dol.gov/ebsa
Website address: www.dol.gov/ebsaToll free telephone: 1 (866)444-3272 (EBSA)Los Angeles Regional Office telephone:
626-229-1000Address: U.S. Department of Labor
EBSA1055 E Colorado Blvd Ste 200
Pasadena, CA 91106
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