Short answer: In Louisiana, the insurer—not the employer—is responsible for notifying individuals of their State Continuation rights.
Compliance
What is Texas State Continuation coverage?
Short answer: Texas State Continuation is a Texas law that allows individuals to temporarily continue fully insured group medical coverage after losing eligibility, either for up to 9 months or for up to 6 months after COBRA ends.
Can an agent help a client with Form 5500 compliance?
Yes. Agents can guide clients on whether a 5500 is required and help connect them with vendors, but employers are ultimately responsible for filing.
Do employers with only HSAs or QSEHRAs have to file Form 5500?
No. HSAs and QSEHRAs are not subject to ERISA, so they don’t trigger Form 5500 filing requirements on their own.
Is an SPD required to file Form 5500?
Yes. An SPD is a core ERISA requirement and should support any Form 5500 filing for a health or welfare benefit plan.
What documentation should be kept to support a Form 5500 filing?
Employers should keep SPDs, Wrap documents, insurance certificates, and proof of distribution to support their Form 5500 filing in case of an audit.
What’s the difference between Form 5500 and Form 5500-SF?
Form 5500-SF is a simplified version used for small retirement plans. Health and welfare plans must use the full Form 5500, not the short form.
What is a Plan Number, and how is it assigned?
A plan number is a unique three-digit identifier assigned by the employer for ERISA reporting. Most health and welfare plans use numbers starting at 501.
Can multiple benefits be reported on one Form 5500?
Yes. If the benefits are combined under a single ERISA plan using a Wrap document, they can be reported on one Form 5500 filing.
What is a “plan year,” and how does it affect the Form 5500 deadline?
The plan year is the 12-month period defined in the SPD or Wrap document and determines the Form 5500 filing deadline.
What’s the penalty for not filing Form 5500?
The DOL can impose penalties of over $2,500 per day for late or missing Form 5500 filings—though a voluntary correction program can reduce the fine.
When is Form 5500 due?
Form 5500 is due the last day of the seventh month after the plan year ends—typically July 31 for calendar-year plans.
Which types of benefit plans require a Form 5500 filing?
Group health, dental, vision, life, disability, and other ERISA-covered welfare benefit plans may require a Form 5500 if they cover 100+ participants or hold assets in trust.
Do small employers have to file Form 5500?
Usually not. Most small employers are exempt from Form 5500 filing unless they have 100 or more participants or offer a funded plan.
What is Form 5500, and who has to file it?
Form 5500 is an annual report required for most ERISA-covered benefit plans with 100 or more participants. It provides plan and financial information to the DOL.
Does the SBC need to list specific plan dates, or is a plan year reference enough?
Short answer: Federal guidance expects SBCs to list the specific coverage period, but some carriers issue SBCs labeled by plan year; employers typically rely on the most current version provided by the carrier.
Are SBCs required for an HRA (Health Reimbursement Arrangement)?
Short answer: It depends on the HRA’s structure. SBCs are not required for standalone HRAs, but if an HRA is integrated with a group health plan, the plan’s SBC must reflect the HRA’s impact on coverage and cost-sharing.
Where can agents get a template or sample SBC?
Short answer: Agents can obtain official SBC templates and instructions from federal agencies, and plan-specific SBCs from insurance carriers or third-party administrators.
What languages must SBCs be provided in?
Short answer: SBCs must be provided in non-English languages when federal thresholds are met, and a notice of language availability must be included if at least 10% of a county’s population is literate only in the same non-English language.
Can SBCs be customized with an agency’s branding or contact info?
Short answer: Generally no. SBCs must follow a strict federal template and cannot include agency branding or promotional material, although limited plan or employer contact information may appear in designated areas.
How do SBCs relate to SPDs (Summary Plan Descriptions)?
Short answer: An SBC is a short, standardized snapshot of health coverage required under the Affordable Care Act, while an SPD is a detailed legal document required under ERISA; both are required, but they serve different purposes.
Are SBCs required for dental and vision plans?
Short answer: No. SBCs are generally required only for major medical coverage and do not apply to stand-alone dental or vision plans.
Is there a penalty for providing an inaccurate or outdated SBC?
Short answer: Yes. Providing an inaccurate, incomplete, or outdated SBC can result in penalties of up to $1,000 per affected individual, per violation, and may trigger federal enforcement actions.
Do SBCs need to be updated mid-year if plan changes occur?
Short answer: Yes. If a plan change materially affects the content of the SBC and occurs outside of renewal, an updated SBC must generally be provided at least 30 days before the change takes effect.
How are SBCs delivered—electronically or in print?
Short answer: SBCs may be delivered either electronically or in paper form, but electronic delivery is allowed only if specific federal requirements are met.