Compliance Facts - ERISA, PPACA and Employment Laws
The Patient Protection and Affordable Care Act (PPACA; Pub. L. No. 111-148) i.e. s a federal statute that was signed into law in the United States by President Barack Obama on March 23, 2010. Along with the Health Care and Education Reconciliation Act of 2010 (signed into law on March 30, 2010), the Act is a product of the health care reform agenda of the Democratic 111th Congress and the Obama administration. — Excerpted from Patient Protection and Affordable Care Act on Wikipedia Compliance for Employers and what is required:
- Provide a Summary Plan Description (SPD) for each health and welfare benefit plan offered or an SPD Wrap creating an overall SPD for all benefits wrapped in one document with required ERISA language. Note: The Summary of Benefits and Coverage (SBC) issued by providers do not meet SPD requirements, and small employers are not exempt.
- Provide required annual notices such as: Medicare Part D, WHCRA, NMHPA, HIPAA, CHIP, Mental Health Parity Act, and more depending on company size and other criteria.
- Provide triggering event notices like COBRA, FMLA, HIPAA Breach, and Medical Child Support Order Notice.
- Comply with healthcare reform changes and deadlines associated with the Patient Protection and Affordable Care Act.
- Comply with the many federal and state laws governing employee rights like FLSA, FMLA, ADA, OSHA, IRCA, EPA, ERISA, USERRA, PPACA, Title VII Civil Rights Act, PDA, GINA and more.
Enforcement and Audits:
Enforcement and audits from the DOL, IRS and EEOC have significantly increased, with particular focus being placed on smaller organizations (< 100). Enforcers are aggressively seeking compliance and fines to fund PPACA and deficit.
The DOL’s Employee Benefits Services Administration (EBSA) routinely conducts group health benefit plan ERISA audits.
The Health Benefits Security Project (HBSP) was created under PPACA for additional focus on health plan compliance and on civil and criminal investigations.
The DOL estimates three out of four plans audited have an ERISA violation, and 70 percent of audit violations result in monetary fines to the employer.
- Penalties are enforced for failure to comply with ERISA up to $110/day penalty for every employee that is affected.
- Penalties of up to $1,000 per day may be assessed against plan administrators who fail to comply with annual reporting.
- Employers are receiving penalties – up to a $17,475– for failure to provide an SPD, thinking the certificate of insurance was enough.
- 67% of the time, if an employment lawsuit goes to trial, plaintiffs (employees) are more likely to win.
- Wrongful termination lawsuits have risen 260 % in the past 20 years with the average cost to settle an employee lawsuit for the small business owner of $326,000, plus attorney fees. Many fines and lawsuits are over $1,000,000.
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