The forth quarter is on us and there is no better time to make sure you have your ERISA documents up-to-date!
The Department of Labor (DOL or the Department) has made it clear, in no uncertain terms, that its sights are set on health and welfare plans for increased scrutiny going forward. At a recent International Foundation of Employee Benefit Plans (IFEBP) conference in San Francisco, the DOL reported that it is actively seeking out health and welfare plans across the country, examining Form 5500 filings, medical claims, prescription drug programs and plan documents.
Form 5500 Filings
As its first order of business, the DOL is identifying health and welfare plans that may be delinquent in their Form 5500 filings. Knowing that generally, when there is a pension plan, there is also a related health and welfare plan, the DOL is seeking out families of funds to detect filing delinquencies.
The DOL recognizes that all plans are not the same and that each plan offers different benefits; therefore, a lot of the focus will be on the various plan documents and agreements that are the basis for the benefits that are paid. Benefits must be paid in accordance with plan documents on behalf of eligible participants and must be properly recorded in the financial statements.
How to Respond
In light of the increased DOL scrutiny on health and welfare plans, now is a good time for trustees and plan administrators to take action. You will want to review plan documents to verify that they sufficiently describe the benefits offered by the plan and also the process by which a plan participant can appeal a denied claim. Also consider reviewing agreements with service providers for transparency and fee appropriateness. Plans with self-funded claims will want to review claims processing procedures to make sure they are appropriately designed to address the risk of errors or fraud. Now is the time to be proactive. Be prepared before the DOL comes knocking on the door.
Call or email Elisa@icusa-tx.com for more information.