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Five Costly Health Care Compliance Slips

CFO (03/12) David McCann

In the past, the U.S. Department of Labor focused more on retirement plan compliance, but the agency is turning its attention to health benefit plans due to federal health care reform. Small companies without a human resources team may not maintain a required plan document that details claims procedures and eligibility provisions under the Employment Retirement Income Security Act. Many assume that insurance contracts satisfy ERISA standards, but DOL audits increasingly focus on both plan documents and insurance contracts, with companies not providing such documents within 30 days of an employee’s request facing fines up to $110 per day. Small firms also may neglect to retain plan-related documents for a sufficient time after the end of the plan year; ERISA mandates that such documents be retained for six years, but some states have longer statutes of limitations on claims against health plans.

Small firms also must comply with the Health Insurance Portability and Accountability Act of 1996, with the DOL undertaking audits of employers, who face penalties up to $2,500 per incident of noncompliance per standard. Under the federal health care reform law, companies with 250 or more employees must report all prior-year costs for health insurance paid by the employer and the employee on the employee’s Form W-2 beginning in 2013, with a $200 fine per form for incorrect information. Moreover, beginning Sept. 23, 2012, employers must provide a Summary of Benefits and Coverages document during open enrollment or face an excise tax of $100 per plan participant per day of noncompliance.