The Department of Labor (DOL) has proposed revisions to the Form 5500 reporting requirements. Most will be effective with the 2019 plan year, with some effective prior to that. With these changes, millions of small group health plans that are currently exempt from filing the Form 5500 Annual Return (such as fully insured and/or unfunded plans with fewer than 100 participants) may be required to file annual reports.
Benefit plans subject to the Employee Retirement Income Security Act (ERISA) are generally required to electronically file annual reports, including information such as the financial condition and operations of the plan. The Form 5500 is used for this purpose.
Reason for Changes
The proposed changes are intended to increase transparency of plan financial transactions, collect additional data, improve data mining, and modernize reporting requirements. The changes would provide critical compliance data to the DOL, the IRS, and the Pension Benefit Guaranty Corporation (PBGC), all of which have oversight responsibilities. The data would also be used for congressionally mandated reports on group health plans.
- Eliminate the exemption from Form 5500 reporting for certain small benefit plans. Only a limited number of questions would need to be answered by certain small group health plans.
- Schedule J (new) would require reporting of data such as:
- How many individuals are receiving COBRA under the plan; rebates or reimbursements received from a service provider; total premium payment and other details regarding stop-loss coverage; employer and employee contribution information; who may be covered (spouses, dependents, etc.).
- Claims data such as: counts of claims paid (including dollar amount) and claims denied; number of benefit claim appeals (and appeal results), number of claims adjudicated late; whether the plan was unable to pay claims at any time during the year.
- Self-reporting compliance with federal laws (such as the Health Insurance Portability and Accountability Act, the Genetic Information Nondiscrimination Act, and the Affordable Care Act).
Although the majority of changes are not expected to be implemented until the 2019 plan year, some changes may be implemented earlier. Benefits administrators should review plan compliance, including plan expenses (especially service provider fees) on an annual basis in preparation for the additional data that should be reported to and scrutinized by the DOL, IRS, and PBGC.