Administrators of ERISA employee benefit plans are required to file an annual Form 5500 or 5500-SF, unless a reporting exemption applies. More specifically, if you are the administrator of a profit sharing plan, stock bonus plan, money purchase plan, 401(k) plan, defined benefit plan, certain 403(b) plans or a welfare benefit plan, generally you must file a Form 5500 or 5500-SF for the plan each year.
Certain welfare benefit plans are exempt from all or part of the Form 5500 series reporting requirements. For example, there is an exemption from Form 5500 series reporting for small welfare benefit plans (fewer than 100 participants at the beginning of the plan year) that are unfunded, fully insured or a combination of unfunded and fully insured. More information on which welfare benefit plans are exempt from the Form 5500 series filing requirement is provided below.
In 2002, the IRS suspended the Form 5500 filing requirement for cafeteria plans based on the rationale that cafeteria plans are merely funding vehicles. However, a Form 5500 or 5500-SF is required for any component benefit plan that is an ERISA welfare plan (for example, health FSAs, dental, long-term disability, AD&D and group term life plans) unless an exemption applies.
For example, assume an employer maintains a cafeteria plan to allow employees to pay their health insurance premiums with pre-tax dollars. All ten of the employer’s employees participate in the cafeteria plan and the underlying fully insured health plan. Under this example, the employer does not need to file a Form 5500 for the cafeteria plan and no reporting is required for the health plan because it falls under the Form 5500 filing exemption for small and fully insured welfare benefit plans.
As another example, assume the same facts, except that there are 250 employees participating in the cafeteria plan and underlying fully insured health plan. Under this scenario, a Form 5500 is not required for the cafeteria plan, but the employer must annually file a Form 5500, with all required schedules and attachments, to satisfy the ERISA reporting requirement for the health plan.
Which welfare plans must file a Form 5500 or 5500-SF?
- Large funded plans
- Large unfunded plans
- Large insured plans
- Large combination unfunded/insured plans
- Small funded plans
Exempt from filing:
- Small unfunded plans
- Small insured plans
- Small combination unfunded/insured plans
- Unfunded or insured plans for certain select employees (management or highly compensated employees)
- Employer-sponsored day care centers
- Certain apprenticeship and training plans
- Plans not subject to ERISA
Beginning in 2014, the Affordable Care Act (ACA) establishes the following three risk-spreading programs to provide payments to health insurance issuers that cover higher-risk populations and to more evenly spread the financial risk carried by issuers: a transitional reinsurance program, a temporary risk corridor program and a permanent risk adjustment program.
The transitional reinsurance program is intended to help stabilize premiums for coverage in the individual market during the first three years of Exchange operation (2014 through 2016) when individuals with higher-cost medical needs gain insurance coverage. This program will impose a fee on health insurance issuers and self-insured group health plans. Most health insurers will pass the reinsurance fee to employers who have fully insured health plans. The Clarke & Company Monthly Newsletter covers the compliance and cost impact to employers associated with the Reinsurance Fee.
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For the first time in over thirty years, the Equal Employment Opportunity Commission (EEOC) has provided an update on the subject of pregnancy discrimination by issuing new guidelines under the Pregnancy Discrimination Act (PDA) and the Americans with Disabilities Act (ADA). These guidelines come at a time when there has been an increase in awareness about pregnancy related discrimination issues. In fact pregnancy discriminations claims have increased by 46% between 1997 and 2011. The EEOC has claimed their position on a number of items and the guidance is effective immediately.
First off, the EEOC states that there should be no discrimination between past, present, or future pregnancies. All of these are covered by the PDA which covers all aspects of employment including hiring, firing, promotions, benefits, and treatment. Regarding pregnancy- related medical conditions, the EEOC states that the PDA disapproves the discrimination against women with medical conditions related to pregnancy from those who also have medical conditions unrelated to pregnancy. Furthermore, lactation and breastfeeding are now considered pregnancy related medical conditions under the PDA and employers must allow their employees with these conditions the freedom to address these issues in the same way employees with other medical conditions do.
EEOC’s interpretation of PDA doesn’t allow preferential treatment for pregnant people and workplace conditions should be applied equally to all those who are also unable to work. For example, light duty working conditions should be applied to those with pregnancy related conditions as well as other employees with conditions that make them unable to perform their full duties. The ADA doesn’t categorize pregnancy as a disability but if a worker has impairments from their pregnancy then they may apply. In this circumstance, employers cannot discriminate against women with disability resulting from a pregnancy from others with disabling factors. Employers must provide equal accommodations such as altering job functions, modifying workplace policies, and additional leave.
Employers cannot force an employee to take leave as long as they are able to perform their job. This would violate PDA. In addition, employers must allow women with physical limitations from pregnancy to leave on the same terms as others who are similar in their ability to work. The EEOC also points out PDA doesn’t allow the discrimination between men and women for parental leave which includes bonding or providing care for a new born child. Employers must provide equal leave to new fathers and mothers beyond the period of recuperation from childbirth.
The EEOC has suggested the best practices to avoid violations regarding pregnancy related discrimination under PDA and ADA. They suggest employers review their policies to make sure they are addressing conditions appropriately.
The pay or play rules will take effect for most ALEs (Applicable Large Employers) beginning on Jan. 1, 2015. To prepare for compliance, employers that intend to use the look-back measurement method for determining full-time status for 2015 will need to begin tracking their employees’ hours of service in 2014 to have corresponding stability periods for 2015. Please inquire about the Clarke & Company Full Time Tracking Tool. Our Tracking Tool is designed to simplify measurement period administration.
insurance coverage. Individuals who are eligible for health coverage under COBRA are known as “qualified beneficiaries.” The Affordable Care Act (ACA) made health insurance Exchanges available, beginning Jan. 1, 2014, for individuals and small businesses to purchase health coverage. The Exchanges are health insurance marketplaces where consumers can compare private health insurance options and purchase insurance. Recently, the Department of Labor (DOL) and Health and Human Services (HHS) released several pieces of guidance regarding COBRA, which clarify the impact of the ACA’s Exchanges.