Healthcare Benefits Compliance

Our Healthcare Benefits Compliance services are designed to help your clients navigate and comply with applicable requirements from the IRS and Department of Labor (DOL).  We are here to protect your clients and their employees’ assets – their benefits and funds.  Our team has over 20 years of experience handling benefit compliance.

Compliance Services

When your client decides to offer any kind of benefits to their employees there are regulations and federal laws they are required to comply with.  If they do not comply or are unsure how to comply, they could be penalized.  Employers could also be susceptible to an employee suing them in criminal court.  To ensure your client’s company is following these regulations, ASi offers different healthcare benefits compliance services to establish protection for your client and their employees. Click on the compliance mandate titles for more information about the laws and services ASi offers.

DISCLAIMER: We share this information with our clients and friends for general informational purposes only. It does not necessarily address all of your client’s specific issues. It should not be construed as, nor is it intended to provide, legal advice. Questions regarding specific issues and application of these rules to your client’s plans should be addressed by their legal counsel.

IRS Circular 230 Disclosure: To ensure compliance with requirements imposed by the IRS, we inform you that any U.S. federal tax advice contained in this communication (including any attachments) is not intended or written to be used, and cannot be used, for the purpose of (1) avoiding penalties under the Internal Revenue Code or (2) promoting, marketing or recommending to another party any transaction or matter addressed herein.

The Affordable Care Act reporting is the action of filing required information to the Internal Revenue Service (IRS) and sending copies to your client’s employees.  The ACA requires your client to file this information annually.  Below are some of the details pertaining to ACA Employer Reporting.

Who Is Affected by This Law?
  • Any person, including self-insured employers that provide Minimum Essential Coverage to an individual during a calendar year must report certain information to the IRS on Form 1094-B and 1095-B, and
  • Applicable Large Employers (ALEs), who within the previous year, had 50 or more full-time employees (including full-time equivalent employees) must report certain information on the IRS Form 1094-C and 1095-C.

Full-time employees are those who work 30 or more hours per week or an average of 130 hours a month.  Some employers may meet the requirements using this as a guideline for ACA reporting, however, some employers may also have seasonal employees and qualify for exemptions for those who work less than 120 days within the year and may not be subject to the filing requirements.

What ASi Can Do for Your Client

We can determine if your client is required to provide the information and reports, analyze your client’s group medical benefits, and compile detailed data through our innovative software.  We produce, mail, and file the required forms to the IRS accurately and on time.  We also provide required documents to your client and their employees.  Depending on your client’s needs, we have 3 service levels to help them with ACA Employer Reporting.

  • Reporting ONLY – This option is for employers who already track eligibility and offers of coverage requirements. Your client would simply provide ASi basic information about their employees, then we code and create individual 1095 C or B forms for distribution. We can also mail forms to reportable individuals. We then electronically file the 1094/1095 forms to the IRS.
  • Tracking AND Reporting – This is our full-service option. ASi will determine monthly full-time/part-time employee status, provide your client with monthly reports to stay in compliance with offers of coverage, code and prepare the 1094/1095 forms, mail forms to employees, and electronically file the forms to the IRS.
  • Filing ONLY – This option is for employers who may have an internal system or program that completes the Form 1094 and 1095, but does not have the capabilities to electronically submit them to the IRS. Your client would provide ASi with all reporting data and coding to allow us to electronically file on your client’s behalf to the IRS.

The Employee Retirement Income Security Act (ERISA) is a federal law that regulates employer group-sponsored benefit plans.  The law has guidelines that require extensive administrative obligations on employers who provide their employees with health and welfare benefit plans. Employer sponsored health and welfare benefits offered by most employers fall under ERISA guidelines. Below are some of the details pertaining to ERISA.

Who is Affected by This Law?

Most employers who offer a group-sponsored benefit plan are required to provide employees with specific plan features and provisions, funding information, and reporting to the government. They face strict deadlines for disclosing plan information to eligible participants and must follow a strict code of conduct. Failure to comply with ERISA requirements can result in costly governmental penalties.

What ASi Can Do for Your Client

We are here to help offload the administrative task of conforming to ERISA guidelines, provide uniformity and protection to all your client’s employees, mitigate employer risk, and provide ongoing administrative support by offering the following services for your client’s health and welfare plans:

  • Tailored ERISA Plan Design
  • Customized Documentation Generation and Participant Notifications
  • Government Reporting
  • Regulatory Guidance and Technical Assistance

To encourage welfare plan administrators to file overdue annual reports (commonly referred to as the Form 5500), the Employee Benefits Security Administration (EBSA), which is a division of the Department of Labor (DOL), developed the Delinquent Filer Voluntary Compliance Program (DFVCP).  This program allows employee benefit plan sponsors, typically the employer, to pay reduced civil penalties for voluntarily complying with the annual reporting requirements. Reduced civil penalties are only available if the required filings are made prior to the date on which the administrator is notified in writing by the DOL of a failure to file a timely annual report under ERISA. Below are some of the details pertaining to DFVCP.

Who is Affected by This Law?

Anyone who may be liable for violations under ERISA, including employee benefit plan sponsors, officials, and parties in interest. They may voluntarily apply for relief from enforcement actions provided they comply with the criteria and satisfy the procedures outlined in the DFVCP.

What ASi Can Do for Your Client

We are here to assist plan administrators by preparing and filing delinquent Form 5500 or Form 5500-SF (for eligible small plans) under the DFVCP. We specialize in Delinquent Form 5500 Filing and will guide your client through the process and complete the filings.

The Department of Labor and IRS will often audit employer’s provided information about their group-sponsored benefits.  The following IRS and DOL departments could audit your information:

Internal Revenue Service (IRS)

  • Reviews Health & Welfare Plan Reporting and ACA Reporting

Department of Labor (DOL)

  • Health & Welfare Plans primary jurisdiction over fiduciary standards, ACA regulations and compliance,
  • Disclosure requirements and general reporting requirements, and Exchange/Marketplace requirements

Some of the common audit findings are:

  • Inaccurate or Late Filings of the Form 5500 Annual Report
  • Not Providing Summary Plan Descriptions (SPDs) for Each ERISA Plan
  • Not Providing ERISA and Health Care Reform Notices
  • Not Generating Summary of Material Modification (SMM) Whenever There are Material Changes to Benefits
  • Inaccurate, Late, or Failure to File Form 1094/1095 Reports
  • Failing to Perform and Pass Nondiscrimination Testing
  • Mental Health Parity Failures
  • Inadequate Claims Procedures
  • Participant Complaints
Who is Affected by This Law?

Any employer who provides a health and welfare benefit plan or must comply with the ACA mandates could potentially be audited by the DOL or IRS.

What ASi Can Do for Your Client

We recognize that employers face strict responsibilities and the regulations can be difficult to navigate. ASi provides comprehensive administration ensuring that employers get and remain compliant with the DOL and IRS requirements.  The services we provide during audits are as follows:

  • Assistance in gathering, preparing, and submitting items to governing bodies
  • Analysis of administration process and procedures
  • Identifying risk
  • Provide recommendations for corrections
  • Assist in implementation of requirements
  • Offer extensive resources and expertise

ASi can help abate or discharge penalties caused from audits.  We have saved our clients over $30 million in penalties to date!

Our clients benefit from our years of experience in ensuring that they remain on the road to compliance by providing the following services:

  • Maintain all required records for the retention period
  • Provide instruction regarding required on-site record-keeping
  • Complete all required forms accurately and promptly
  • Prepare and design the required plan document and the summary plan description
  • Prepare the Summary of Materials Modification (SMM)
  • Provide guidelines for disclosure of required information to employees
  • Prepare all applicable 5500 forms and schedules
  • Prepare the Summary Annual Report (SAR) if required
  • Provide access to experienced employee benefits professionals
  • Maintain ongoing regulatory compliance
  • Provide analysis, recommendations, and reporting for ACA mandates

Certain employer-provided benefits are eligible for tax exclusions under the Internal Revenue Codes. Each tax-advantaged plan comes with an important condition- an employer must be able to demonstrate that the benefit satisfies applicable nondiscrimination tests.

According to regulations, nondiscrimination tests are to be performed as of the last day of the plan year, considering all non-excludable employees who were employed on any day during the plan year. It is recommended that employers do one test mid plan year in order to determine whether additional steps must be taken before the end of the plan year.  A second and final test would then be conducted as of the last day of the plan year.

Below are some of the details pertaining to non-discrimination testing.

Who is Affected by This Law?

Any employer who offers a Cafeteria Plan for Salary Reductions, Flexible Spending Account, Dependent Care Assistance Program, Self-Funded Major Medical, Dental, and Vision Reimbursement Arrangements, Minimum Essential Coverage (MEC) Plans, Fully Insured Major Medical and Dental Plans (pending further guidance), Group Term Life Insurance, Long Term Disability Plans, Accidental Death and Dismemberment Plans, and Plans provided through a Voluntary Employee Beneficiary Association Plan (VEBA) are required to pass the nondiscrimination testing.

  • Eligibility- If enough non-Highly Compensated Employees (HCEs) cannot get into the plan, it will be discriminatory.
  • Benefits- A plan will not pass if the HCEs/Keys are able to get more benefits then the non-HCEs.
  • Utilization- If HCEs/Keys actually take more benefits under the plan then the non-HCEs/Keys the plan will not pass and is often the most difficult to pass, especially for smaller employers.

Ineligible Individuals – Several specific categories of ineligible individuals cannot participate and may cause the entire plan to be disqualified, resulting in taxation to all participants:

  • Self Employed Individuals
  • Sole Proprietors or owners of an LLC,
  • Partners in a Partnership or an LLP,
  • Owners of minimum 2% stock of an S Corporation cannot participate.
  • Outside Directors (if they are not an employee)
What ASi Can Do for Your Client

ASi can perform the testing so your client’s plans stay tax-advantaged, benefiting both employers and employees alike. Your client can rely on our technical expertise for peace of mind in all your compliance needs.  We will conduct several rounds of testing and recommend corrections, if required,  to ensure your client’s plans will pass.

Need Compliance Assistance? Contact our Compliance Team for more information!

Employer Features

Your clients become part of the ASi family, which means providing them with the best features within the industry.  The features listed below are included as part of our administrative services.

  • Risk and Penalty Mitigation
  • Peace of Mind
  • Full-Service Compliance Solutions
  • Online Account Access – Plan Sponsor Link
  • Detailed Resources
  • Dedicated ASi Teams Who Provide Personalized Customer Service
  • Reduced Workload
  • Fair Pricing for Services
  • Competitive Fee Schedules and Potential Cost Savings
  • Management of Documents, Forms, and Record Keeping
  • Reliability
  • Standard Reports
  • Extensive Resources
  • Quick Administration Turnaround
  • Assist in Plan Design, Options, and Features
  • Superior Technology Capabilities
  • Simplicity and Clear Expectations

Want to Know More About this Service?

Check out our FAQs or contact our Sales Team

Phone: 866-777-1320 or 559-256-1320