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Insurance for the California Central Valley

2021 Health Plan Compliance Deadlines

There are many reasons that employers offer employee benefits, most notable to attract and retain key employees.  Benefit offerings are regulated by several key government agencies, from the Internal Revenue Service to the Department of Labor, as well as state government entities. 

If an employer offers a group health plan, employers must comply with numerous reporting and disclosure requirements throughout the year in connection with their group health plans. 

Some of the compliance deadlines summarized below are tied to a group health plan’s plan year.  For these requirements below, we are assuming a calendar year plan that runs from January 1st through December 31st

This Compliance Overview explains key 2021 compliance deadlines for employer-sponsored group health plans, as well as health plan notices that employers must provide each year. 

COVID-19 Conditions

A note related to COVID-19 and deadline extensions: 

At the beginning of the  pandemic, the Department of Labor (DOL) issued the Disaster Relief Notice 2020-01 to extend the time to furnish benefit statements and other notices and disclosures required by ERISA. So that plan sponsors have additional time to meet their obligations during the COVID-19 outbreak.  Under this guidance, an employee benefit plan will not be in violation of ERISA for a failure to timely furnish a notice, disclosure or document that must be furnished between March 1, 2020, and 60 days after the announced end of the COVID-19 National Emergency, if they act in good faith. This means the plan must furnish the documents as soon as administratively practicable under the circumstances.

Health Compliance Deadlines:

  • January 31st:  W-2s are due to employees and some employers that issue 250 or more IRS forms W-2, may be required to report the aggregate cost of employer-sponsored health plan coverage.
  • March 1st:  Section 6055 and 6056 of the IRS code requires applicable large employers (ALE) with fully insured plan file forms 1094-C and 1095-C, and self-funded health plans file forms 1094-B and 1095-B.  These forms report various aspects of access and affordability governed by the Affordable Care Act and the employer’s requirement to offer and/or have health insurance coverage.  Subsequent IRS filings are due after delivering forms to employees, depending on how many 1094/1095 forms are filed for the year (electronic and hard copy deadlines are different).
  • March 1st:  CMS Medicare Part D disclosure.  Requires health plans to report their plan prescription drug status to CMS related to Medicare Part D requirements.
  •  August 2nd:  specific to self-insured health plans, these plans much pay an annual fee to fund the Patient-Centered Outcomes Research Institute (PCORI).  Self-insured health plans that are subject to PCORI fees include self-funded medical plans, as well as HRAs offered in conjunction with fully insured group medical plans. HRAs offered with self-insured group medical plans are not subject to separate PCORI fees if the HRA and the medical plan have the same plan sponsor and plan year.
  • September 30th:  medical loss ratio rebates.  Issuers must spend a minimum percentage of their premium dollars, or medical loss ratio (MLR), on medical care and health care quality improvement. Issuers that do not meet the MLR must pay rebates to consumers.  Rebates must be provided to plan sponsors by September 30, following the end of the MLR reporting year. Employers that receive rebates should consider their legal options for using the rebate. Any rebate amount that qualifies as a plan asset under ERISA must be used for the exclusive benefit of the plan’s participants and beneficiaries.
  • September 30th:  groups that are subject to filing form 5500, are required to provide participants with a summary of the information in the filed Form 5500, called a summary annual report (SAR). The plan administrator generally must provide the SAR within nine months of the close of the plan year.  For calendar year plans, this deadline is Sept. 30, 2021.
  • October 14th:  Medicare Part D notices are due.  Employers with group health plans that provide prescription drug coverage must notify Medicare Part D-eligible individuals by October 14th of each year. Employers must notify whether the drug coverage is at least as good as Medicare Part D coverage (in other words, whether their prescription drug coverage is “creditable” or “non-creditable”).
  • Other notices throughout the year that are required:
    • Summary of benefits and coverage (SBC);
    • Women’s Health & Cancer Rights Act (WHCRA) notice;
    • Children’s Health Insurance Program (CHIP) Notice
    • Summary Plan Description (SPD)
    • Summary of material modifications (SMM)
    • COBRA General Notice
    • Marketplace Notice
    • Grandfathered plan notice
    • Notice of patient protections
    • HIPAA privacy notice
    • HIPAA special enrollment notice
    • Wellness notice for HIPAA & ADA

What is a 5500 Form?

Employers with ERISA group health plans are required to file form 5500, unless an exemption applies.  Form 5500 must be filed by the last day of the 7th month following the end of the plan year, again, unless an extension applies.  For calendar year plans, this deadline is generally July 31.  However, in 2021, this deadline is August 2, 2021, since July 31, 2021, is a Saturday.  An employer may request a one-time extension of 2½ months by filing IRS Form 5558 by the normal due date. If Form 5558 is filed on/before the Form 5500 or 5500-SF due date, the extension is automatic.

We’re here for you!

Team WISG is here to assist our clients with meeting these important deadlines.  We know they can be cumbersome and difficult to understand but we are here to make your compliance easier.  One of our top jobs as your broker is compliance assistance.  Rely on our team to keep your plan compliant so you can focus on other issues. Your account manager will reach out to you at various times in the year to review and assist you with these key deadlines.

Questions? Contact us today!

(800) 790-4875

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