Proposed Changes to Form 5500 Include Expanded Group Health Plan Reporting.

Proposed changes to the forms and regulations that govern annual employee benefit plan reporting on Form 5500 were released recently.  Of particular importance is a proposed new “Schedule J,” which would be filed with the Form 5500 by all group health plans.  Schedule J is intended to implement the “transparency requirements” of the Affordable Care Act which, generally speaking, requires detailed information to be provided to the Department of Labor, the Department of Health and Human Services, the Internal Revenue Service, and state regulators.  While at first glance it may appear that this is the government’s way of performing an “end run” around the Supreme Court’s recent decision in Gobeille v. Liberty Mutual Insurance Co. (striking down a Vermont all-payer claims database law as applied to an ERISA-governed health plan), it appears to us that the information being sought through proposed Schedule J is more “global” in nature and not claim-specific.

If adopted, the revisions to the proposed regulations pertaining to Form 5500 and its accompanying Schedules would apply for plan years beginning on or after January 1, 2019.  The proposed Schedule J would require a broad array of information, including:

  • An estimate of the number of participants and beneficiaries covered under the plan at the end of the plan year;
  • The number of individuals offered COBRA coverage;
  • Whether the plan offers coverage for employees, spouses, children or retirees;
  • What type of group health benefits are offered under the plan (for example, health, surgical, pharmacy or prescription drug, mental health/substance use disorder, wellness program, preventive care, vision, dental);
  • Information on whether the plan is funded through a health insurer and whether benefits are paid through a trust or from an employer’s general assets;
  • Whether there are participant or employer contributions;
  • Total premium payments for stop loss coverage, and information on the attachment points for this coverage, individual claim limits, and the policy’s aggregate claim limits;
  • Whether the plan’s summary plan description (SPD), summaries of material modifications (SMM), and summaries of benefits and coverage (SBC) comply with governing content requirements; and
  • Information regarding claims, such as:
    • How many benefit claim denials were appealed during the plan year;
    • How many appealed claims were upheld as denials, and how many were payable after appeal;
    • Whether any claims for benefits were not adjudicated within the required timeframes; and
    • The total dollar amount of claims paid during the plan year.

Check back with the Benefits Law Insider for updates on the status of proposed forms and proposed regulations pertaining to Form 5500.

Tax-Exempt Employers and Deferred Compensation Arrangements Purusant To Code Section 457(f): Part 1


In this post, we will review the interplay of 457(f) deferred compensation arrangements and the Code Section 409A requirements.


A 457(f) nonqualified deferred compensation arrangement, often referred to as an “ineligible plan,” is a nonqualified retirement plan which gives the tax-exempt employer an opportunity to supplement the retirement income of its select management group or highly compensated employees (collectively, “employee”) by contributing to the ineligible plan amounts that will be paid to the employee at a certain triggering event.   Continue Reading

MassMutual Excessive 401(k) Fee Litigation Settlement


In a preliminary settlement approval filed June 15, 2016, in the case of Gordan v. Mass. Mutual Life Ins. Co., D. Mass., Massachusetts Mutual Life Insurance Co. agreed to pay close to $31 million to settle a 2013 lawsuit claiming that it mishandled its defined contribution plan. Continue Reading

Burwell Case Is Another Challenge to the Affordable Care Act


In the case of House of Representatives v. Burwell, the United States District Court for the District of Columbia has ruled that the United States government wrongly spent billions of dollars in the past two years to reimburse insurance companies for providing health coverage at lower costs.  This case stems from the Affordable Care Act (ACA) provision that requires the government to directly reimburse insurance companies for the “cost-sharing reductions” they provide to low and moderate income consumers.  This is done specifically through reduced deductibles, coinsurance, copayments and similar expenses incurred by individuals enrolled in the Exchanges created under the ACA. Continue Reading

Church Pension Lawsuit Settled by Saint Francis Hospital and Medical Center


In a class action suit filed in July 2015, Kemp-DeLisser v. Saint Francis Hospital and Medical Center et al., Kemp-DeLisser, a pension plan participant, alleged that Saint Francis Hospital and Medical Center (Saint Francis) wrongly classified its pension plan as a “church plan.”  Church plans are not subject to the federal Employee Retirement Income Security Act (ERISA), which protects employees by requiring that pension plans be insured and sufficiently funded.  Kemp-DeLisser alleged that Saint Francis failed to adhere to ERISA’s minimum funding standards. Continue Reading

Marin v. Dave & Buster’s – Class Action Complaint


In Maria De Lourdes Parra Marin (Plaintiff) v. Dave & Buster’s, Inc., a federal district judge in the Southern District of New York has denied a motion to dismiss a class action claim against the employer, Dave & Buster’s, Inc. (D&B).  The class consists of approximately 10,000 individuals employed by D&B in the United States.  D&B is the sponsor of an ERISA health insurance plan.  The Plaintiff’s class action claim alleges that D&B violated ERISA by cutting employee hours to avoid providing health insurance benefits to certain employees.   Continue Reading

Late Premium Payments? PBGC Proposes Relief in Form of Reduced Penalties


The Pension Benefit Guaranty Corporation (“PBGC”), the federal government agency responsible for guarantying U.S. private-sector defined benefit pension plans, has proposed regulations that will provide relief for penalties assessed for late premium payments. Continue Reading

Local Wisdom on Employee Benefit Audits


Last week I had the opportunity to read Janet M. Nahorney’s article in the Connecticut Law Tribune on “Preparing for Audits of Employee Benefit Plans.”  Members of our firm can attest to the fact that Ms. Nahorney, a CPA at a regional business advisory firm, is a professional dedicated to employee benefit plan audits as a meaningful part of her business.

Continue Reading

The New Fiduciary Rule: It’s ALIVE!!


After more than five years of hibernation in the limbo that is “proposed rule status,” the new fiduciary rule was given life on April 6 when the Department of Labor (DOL) released the finalized fiduciary regulations.  With this release, the DOL brings finality to one of the most hotly debated and highly anticipated ERISA topics. Continue Reading

Healthcare Providers, Health Plans, & Health Insurers – Are You Ready? HIPAA Phase 2 Audits Have Begun


Attention health care providers – both individuals and group practices – as well as health insurers, HMOs, self-funded health plans, clinics, nursing homes, pharmacies and other covered business entities – start checking your inboxes or your spam folders today:  Phase 2 of the HIPAA Audit Program is hereContinue Reading