Benefits Compliance

Filings, notices, plan documents and state leave programmes. The obligations that arrive quietly and are expensive to have missed.

Why this page exists

Nobody sends a reminder.

Offering a health plan creates obligations under ERISA, the Internal Revenue Code and a growing list of state statutes. None of them announce themselves. Most employers discover a gap during an audit, a Department of Labor enquiry, or a routine question from an employee that turns out not to be routine.

Leave & absence

State paid family and medical leave, coordinated with FMLA, disability and your own policy. Remote employees quietly put you in several states at once.

ACA reporting

§6055 and §6056 filings, and the §4980H penalties those filings are used to assess. Applies at fifty full-time equivalents.

Plan documents

ERISA wrap and SPD, Section 125 cafeteria plan, and the written instruments an ICHRA or QSEHRA must have before a dollar is reimbursed.

Form 5500

The annual return for welfare plans at a hundred participants and above. The per-day penalty for not filing is the one worth taking seriously.

COBRA

Election notices, timing, premium collection and termination. The deadlines are short and the consequence of missing one is a funded claim you did not price for.

Notices and timing

Summary of Benefits and Coverage, CHIP, Medicare Part D creditable coverage, Women's Health and Cancer Rights, and the rest of the annual distribution list.

The three gaps we find most often

No wrap document

The employer believes the carrier's certificate of coverage is the Summary Plan Description. It is not, and it never has been. It is missing most of what ERISA requires an SPD to contain.

A Section 125 plan that exists in payroll but not on paper

Premiums are being deducted pre-tax, which requires a written cafeteria plan document. Frequently there is not one, or there is one from 2009 that has never been restated.

A 5500 nobody knew was due

The plan crossed a hundred participants two years ago and nothing changed visibly. The penalty accrues per day, per plan, and it runs from the original due date rather than from the day anyone noticed.

All three are inexpensive to fix and expensive to leave. Ask us to look — a review of what exists takes us about a week and costs nothing.

Request a review

Send the renewal, and we will tell you what we would change

No fee, and no obligation to move the business. Most employers who contact us are simply trying to work out whether the number in front of them is a fair one.

We reply to enquiries within one business day. We do not sell or share contact details.

Waugh Agency has advised employers on health and welfare benefits since 1985. Our full site — including Medicare, individual and travel coverage — is at waughagency.com.