U.S. Department of Labor Employee Benefits Security Administration (EBSA) Pension & Health Plan Options for Small Business Owners.

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