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Administration and Compliance

For any employer, compliance with federal and state laws and regulations is critical. Every organization that chooses to provide benefits to employees is required to comply with numerous legal requirements. Recent changes have made benefits compliance increasingly complex and challenging.

Our team of benefits experts continually monitors the changing compliance landscape, enabling us to help our clients stay within the sometimes confusing and always evolving guidelines established by the government.

Compliance with ERISA and other Federal and State Acts

Employee Retirement Income Security Act of 1974 (ERISA) sets minimum protection standards for plan participants.  These requirements apply to nearly all employer-sponsored group health plans, whether fully insured or self-funded.

For plans covered under ERISA regulations, Form 5500 submission is a critical activity.  This form serves as an annual report to the U.S. Department of Labor (DOL) and provides the DOL with specific plan information.  At Sullivan, we are experts when it comes for Form 5500 submission and we provide our clients with comprehensive submission services.

In addition to ERISA, compliance issues are created by the Family and Medical Leave Act of 1993 (FMLA), the Consolidated Omnibus Budget Reconciliation Act (COBRA) and the Health Information Portability and Accountability Act (HIPAA).

The employee’s employment cycle includes a number of compliance milestones or triggers.  These benefits compliance activities can be categorized in four areas.

  1. New Hire Benefits Compliance Hiring a new employee who is eligible for employer-provided health plans begins the compliance process.  These employees must be given a number of notifications, disclosures and summaries regarding their benefits.  At Sullivan, we help you navigate through this paperwork so that important documents are not inadvertently overlooked.
  2. New Enrollee Benefits Compliance Once an employee is onboard and enrolled in a benefits plan, employers must give the employee more notifications.  These notifications include, among others, COBRA notification and a Summary Plan Description.  If the plan is self-funded, additional notifications are required.  Again, Sullivan partners with its clients to help make sure all of the proper notifications are made.
  3. Open Enrollment Benefits Compliance While ERISA does not require an annual open enrollment period, many benefits carriers do.  Plus, Section 125 cafeteria plans that allow employees to pay health plan costs with pre-tax dollars brings with it a number of compliance requirements.  The open enrollment period triggers annual notifications for a variety of topics.  These include information pertaining to pre-existing conditions, prior insurance coverage (“Creditable Coverage”), Medicare Part D Disclosure Notifications and many others.  Open enrollment can be a very taxing time for employers and having a trusted partner like Sullivan at your side is invaluable.
  4. Benefits Coverage Termination Compliance Typically, when an employee is terminated from employment their eligibility for employer-sponsored health coverage is terminated as well. There are other situations that can also cause eligibility to be terminated, such as a reduction in work hours or the discovery that the employee was actually not eligible for coverage in the first place. Even non-payment of premiums can cause eligibility to end. These situations all result in the need to provide the employee with information on their COBRA coverage. Not surprisingly, numerous compliance issues come into play here.

 

Sullivan:  Your Trusted Resource for Benefits Compliance

Sullivan has developed highly effective tools to ensure health benefits compliance for its clients. Comprehensive checklists, ongoing plan reviews, and day-to-day oversight of plan activity give our clients the peace-of-mind they need when it comes to the highly complex administration of health benefits and its related compliance activities.

What Others Say About Us

Sullivan does a great job of taking care of people like us. We are a service partner and there are many other people in profession who would like to subjugate us being a hired hand, a vendor. With Sullivan, we are treated as professionals and with respect, and we are treated with a lot of appreciation.

Michael BrackenCEOMedcom
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