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SMALL
BUSINESS HANDBOOK
Retirement and Health Benefit
Standards
Employee Benefit Plans |
Employee Retirement Income
Security Act (ERISA),
(29
USC §1001 et seq., 29
CFR 2509 et seq.)
Who is Covered
The provisions of Title I of ERISA cover most private
sector employee benefit plans. Employee benefit plans are voluntarily
established and maintained by an employer, an employee organization,
or jointly by one or more such employers and an employee organization.
Pension plans--a type of employee benefit plan--are established and
maintained to provide retirement income or to defer income until termination
of covered employment or beyond. Other employee benefit plans are called
welfare plans and are established and maintained to provide health benefits,
disability benefits, death benefits, prepaid legal services, vacation
benefits, day care centers, scholarship funds, apprenticeship and training
benefits, or other similar benefits.
In general, ERISA does not cover plans established
or maintained by governmental entities or churches for their employees,
or plans which are maintained solely to comply with applicable workers
compensation, unemployment or disability laws. ERISA also does not cover
plans maintained outside the United States primarily for the benefit
of nonresident aliens or unfunded excess benefit plans.
Basic Provisions/Requirements
ERISA sets uniform minimum standards to assure that
employee benefit plans are established and maintained in a fair and
financially sound manner. In addition, employers have an obligation
to provide promised benefits and satisfy ERISA's requirements for managing
and administering private pension and welfare plans. The Department's
Pension and Welfare Benefits Administration
(PWBA), together with the
Internal Revenue Service (IRS) , carries out its statutory and
regulatory authority to assure that workers receive the promised benefits.
The Department has principal jurisdiction over Title I of ERISA,
which requires persons and entities who manage and control plan funds
to:
- Manage plans for the exclusive benefit of participants
and beneficiaries;
- Carry out their duties in a prudent manner and
refrain from conflict-of-interest transactions expressly prohibited
by law;
- Comply with limitations on certain plans' investments
in employer securities and properties;
- Fund benefits in accordance with the law and
plan rules;
- Report and disclose information on the operations
and financial condition of plans to the government and participants;
- Provide documents required in the conduct of
investigations to assure compliance with the law.
The Department also has jurisdiction over the prohibited
transaction provisions of Title II of ERISA. However, the IRS administers
the rest of Title II of ERISA, as well as the vesting, participation,
nondiscrimination and funding standards of Title I of ERISA.
Reporting and Disclosure
Any individual or organization affected by ERISA
may request an advisory opinion or information letter regarding the
interpretation or application of the statutory provisions (or the implementing
regulations, interpretive bulletins or exemptions) within the Departments
jurisdiction. ERISA Procedure 76-1, 41 Federal Register 36281
(August 27, 1976), sets forth the procedures governing the advisory
opinion process.
Part 1 of Title I requires the administrator of
an employee benefit plan to furnish participants and beneficiaries with
a summary plan description (SPD), describing in understandable terms,
their rights, benefits and responsibilities under the plan. Plan administrators
are also required to furnish participants with a summary of any material
changes to the plan or changes to the information contained in the summary
plan description. Copies of these documents are not required to be automatically
filed with the Department, but must be furnished to the Department on
request.
In addition, the administrator generally must file
an annual report (Form 5500 Series) each year containing financial and
other information concerning the operation of the plan. Plans with 100
or more participants file the Form 5500. Plans
with fewer than 100 participants file the Form 5500-C/R;
the form 5500-C at least every third year and the Form 5500-R, an abbreviated
report, in the two intervening years. Plan administrators must furnish
participants and beneficiaries with a summary of the information in
the annual report.
Certain pension and welfare benefit plans may be
exempt from the requirement to file an annual report. For example, welfare
benefit plans with fewer than 100 participants that are fully insured
or unfunded within the meaning of the Departments regulation at
29
CFR 2520.104-20 are not required to file an annual report.
The Departments regulations governing these
reporting and disclosure requirements are set forth beginning at 29
CFR 2520.101-1.
Fiduciary Standards
Part 4 of Title I sets forth standards and rules
governing the conduct of plan fiduciaries. In general, persons who exercise
discretionary authority or control over management of a plan or disposition
of its assets are "fiduciaries" for purposes of Title I of
ERISA. Fiduciaries are required, among other things, to discharge their
duties solely in the interest of plan participants and beneficiaries
and for the exclusive purpose of providing benefits and defraying reasonable
expenses of administering the plan. In discharging their duties, fiduciaries
must act prudently and in accordance with documents governing the plan,
to the extent such documents are consistent with ERISA. Certain transactions
between an employee benefit plan and "parties in interest,"
which include the employer and others who may be in a position to exercise
improper influence over the plan, are prohibited by ERISA and may trigger
civil monetary penalties under Title I of ERISA. Most of these transactions
are also prohibited by the Internal Revenue Code ("Code").
The Code imposes an excise tax on "disqualified persons" --
whose definition generally parallels that of parties in interest --
who participate in such transactions.
Exemptions
Both ERISA and the Code contain various statutory
exemptions from the prohibited transaction rules and give the Departments
of Labor and Treasury, respectively, authority to grant administrative
exemptions and establish exemption procedures.
Reorganization Plan No. 4 of 1978 transferred the authority of the Treasury
Department over prohibited transaction exemptions, with certain exceptions,
to the Labor Department.
The statutory exemptions generally include loans
to participants, the provision of services necessary for operation of
a plan for reasonable compensation, loans to employee stock ownership
plans, and investment with certain financial institutions regulated
by other State or Federal agencies. (See ERISA section 408 for the conditions
of the exemptions.) Administrative exemptions may be granted by the
Department on a class or individual basis for a wide variety of proposed
transactions with a plan. Applications for individual exemptions must
include, among other information:
- A detailed description of the exemption transaction
and the parties for whom an exemption is requested;
- Reasons a plan would have for entering into the
transaction;
- Percentage of assets involved in the exemption
transaction;
- The names of persons with investment discretion;
- Extent of plan assets already invested in loans
to, property leased by, and securities issued by parties in interest
involved in the transaction;
- Copies of all contracts, agreements, instruments
and relevant portions of plan documents and trust agreements bearing
on the exemption transaction;
- Information regarding plan participation in pooled
funds when the exemption transaction involves such funds;
- Declaration, under penalty of perjury by the
applicant, attesting to the truth of representations made in such
exemption submissions;
- Statement of consent by third-party experts acknowledging
that their statement is being submitted to the Department as part
of an exemption application.
The Department's exemption procedures are set forth
at 29
CFR 2570.30 through 2570.51.
Enforcement
ERISA confers substantial law enforcement
responsibilities on the Department. Part 5 of ERISA Title I
gives the Department authority to bring a civil action to correct violations
of the law, gives investigative authority to determine whether any person
has violated Title I, and imposes criminal penalties on any person who
willfully violates any provision of Part 1 of Title V.
Health Insurance Portability and Accountability
Act of 1996
The Health Insurance Portability and Accountability
Act of 1996 (HIPAA), Pub. L. 104- 191,was enacted on August 21, 1996.
HIPAA amended ERISA to provide for, among other things, improved portability
and continuity of health insurance coverage provided in connection with
employment. The HIPAA portability provisions relating to group health
plans and health insurance coverage offered in connection with group
health plans are set forth under a new Part 7 of Subtitle B of Title
I of ERISA. These provisions include rules relating to preexisting conditions
exclusions, special enrollment rights, and prohibition of discrimination
against individuals based on health status- related factors.
Continuation of Health Coverage
Continuation of health care provisions were enacted
as part of the Consolidated Omnibus Budget Reconciliation Act of 1985
(COBRA) and are codified in Part 6 of Title I of ERISA. These provisions
apply to group health plans of employers with 20 or more employees on
a typical working day in the previous calendar year. COBRA gives participants
and beneficiaries the right to maintain, at their own expense, coverage
under their health plan that would be lost due to a triggering event,
such as termination of employment at a cost that is comparable to what
it would be if they were still members of the employer's group. Plans
must give covered individuals an initial general notice informing them
of their rights under COBRA and describing the law. The law also places
notification obligations upon plan administrators, employers, and qualified
beneficiaries with regard to certain qualifying events.
In most instances of employee death, termination, reduced hours of employment,
entitlement to Medicare, or bankruptcy, it becomes the employer's responsibility
to provide a specific notice to the plan administrator. The plan administrator
must then notify the qualified beneficiaries the opportunity to elect
continuation coverage.
The Department's regulatory and interpretive jurisdiction
over the COBRA provisions is limited to the COBRA notification and disclosure
provisions.
Jurisdiction of the Internal Revenue Service
The IRS has regulatory and interpretive responsibility
for all provisions of COBRA not under the Department's jurisdiction.
In addition, ERISA provisions relating to participation, vesting, funding
and benefit accrual, contained in parts 2 and 3 of Title I, are generally
administered and interpreted by the Internal Revenue Service.
Assistance Available
PWBA has numerous general publications
designed to assist employers and employees in understanding their obligations
and rights under ERISA. A list of PWBA booklets and pamphlets is available
by writing to: Publications Desk, PWBA, Division of Public Affairs,
Room N-5656, 200 Constitution Ave., NW, Washington, DC 20210. Many of
these documents are available via PWBAs homepage.
Individualized assistance is offered by PWBAs
national and
field offices
for persons seeking information and assistance on benefits and rights
under employee benefit plans. PWBA also issues advisory opinions and
information letters in response to requests from individuals and organizations.
Advisory opinions apply the law to a specific set of facts, while information
letters merely call attention to well-established principles on interpretations.
Further information about these programs is contained in PWBAs
booklet on Customer Service Standards.
In addition, employee benefit plan documents and
other materials are available from the PWBA Public Disclosure Room.
This facility may be used to view and to obtain copies of materials
on file. Materials include: summary plan descriptions, Form 5500 Series
reports, Master Trust reports, 103-12 Investment Entity Reports, Common
or Collective Trust or Pooled Separate Account direct filings, Apprentice
and Other Training Plans notices, "Top Hat" plan statements,
advisory opinions, exemptions, announcements and transcripts of public
hearings and proceedings.
The PWBA Public Disclosure Room is open to the public
Monday through Friday, from 8:30 a.m. to 4:30 p.m. Copies of materials
are available at a cost of 15 cents per page by ordering in person or
writing to: PWBA Public Disclosure Room, U.S. Department of Labor, Room
N-5638, 200 Constitution Ave., NW, Washington, DC 20210. Given the complexity
of ERISA requirements, employers may wish to seek the assistance of
an attorney, CPA firm, investment or brokerage firm, and other employee
benefit consultants in complying with the law.
Penalties
PWBA has authority under ERISA Section 502© to assess
civil penalties for reporting violations and prohibited transactions
involving a plan. A penalty of up to $1,000 per day may be assessed
against plan administrators who fail or refuse to comply with annual
reporting requirements. Section 502(I) gives the agency authority to
assess civil penalties against parties in interest who engage in prohibited
transactions with welfare and nonqualified pension plans. The penalty
can range from five percent to 100 percent of the amount involved in
a transaction. A parallel provision of the Code directly imposes an
excise tax against disqualified persons, including employee benefit
plan sponsors and service providers, who engage in prohibited transactions
with tax-qualified pension and profit sharing plans. Finally, the Department
is required under Section 502(l) to assess mandatory civil penalties
equal to 20 percent of any amount recovered with respect to fiduciary
breaches resulting from either a settlement agreement with the Department
or a court order as the result of a lawsuit by the Department.
Relation to State, Local and Other Federal Laws
Part 5 of Title I provides that the provisions of
ERISA Titles I and IV supersede State and local laws which "relate
to" an employee benefit plan. ERISA, however, saves certain state
and local laws from ERISA preemption, including state insurance regulation
of multiple employer welfare arrangements (MEWAs). MEWAs generally constitute
employee welfare benefit plans or other arrangements providing welfare
benefits to employees of more than one employer, not pursuant to a collective
bargaining agreement.
In addition, ERISA's general prohibitions against
assignment or alienation of pension benefits do not apply to qualified domestic relations
orders. Plan administrators must comply with the terms of orders
made pursuant to State domestic relations law and award all or part
of a participant's benefit in the form of child support, alimony, or
marital property rights to an alternative payee (spouse, former spouse,
child or other dependent). In addition, group health plans covered by
ERISA must provide benefits in accordance with the applicable requirements
of qualified medical child support order issued under State domestic
relations laws.
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