2014 Year-End Plan Doc Checklist

Section 125 Cafeteria Plan Amendments

1. $500 FSA rollever versus 2-1/2 month grace period. FSAs can have one but not both. Amendment must be adopted by end of plan year from which funds will be rolled over, so if you want to allow rollovers from 2014 to 2015, you must amend by December 31, 2014.
2. Exchange-related qualified changes in status. In order to permit a mid-year election change on account of federal or state exchange (i.e., "marketplace") enrollment/disenrollment, the plan doc must state that it is allowed. The IRS expanded the list of status changes, so if you want to allow them, the plan doc needs to be amended. Amendment is technically not required until the end of the year following this change, but why wait?
3. FSA annual contribution limit for 2015. If your 125 doc has a fixed dollar amount in it (as opposed to a regulatory cross-reference), then you must amend your plan doc before year-end. This type of change can only be prospective, meaning the amendment must be adopted on or before the effective date of the change. 

ACA-Required Changes

1. Break-in-service and rehire eligibility rules. Review and, if necessary, change break-in-service and rehire eligibility provisions to match IRS definition of "full-time employee."
2. General eligibility requirements. The IRS "full-time employee" definition has wreaked havoc in HR departments that have tackled it, but they're better off for having done so. No good deed goes unpunished, though, so the reward for having figured out how the whole monthly and look-back measurement period stuff works is a plan amendment to square actual eligibility and hiring practices with both the IRS definition and the plan document. 
   

Changes/Additions to Umbrella Wrap Docs & Single-Benefit ERISA Wrappers

1. Same-sex spouse eligibility. The law here has been in flux all year. If an employer does not want to offer coverage to same-sex spouses, its eligibility language needs to say "opposite-sex spouse." If an employer does want to offer coverage to same-sex spouses, it should state that as well. Ambiguity is not your friend. Amendments like these must be made by the end of the plan year in which the change is made.
2. HIPAA hybrid entity designation. This makes sure benefits not intended to be subject to HIPAA aren't inadvertently made subject to HIPAA. Consists of a list of benefits or plan components subject to HIPAA and not subject to HIPAA.
3. No employee contributions allocable to stop-loss. This might be overkill, but as long as we're amending things, might as well. Plan asset issues are near the top of the DOL's list, so in addition to stating that MLR rebates are employer assets (and not plan assets), let's make sure stop loss is also clearly an employer asset.

Medicare Secondary Payer Amendments for Self-Insured Plans

These aren't required by anyone, but you can learn from our experience and limit certain MSP exposure for your self-insured plan. (The carrier bears the risk in insured arrangements.) CMS' recovery contractors (glorified bill collectors) are making some pretty ridiculous arguments in an attempt to recover on some pretty old claims. Head off at least one of the arguments at the pass by making a few changes to the plan document:

1. Include a tack-on amendment for your wrap doc that establishes an outside limit on (a) claims filing deadlines (i.e., X number of days after date of service) and (b) appeal filing deadlines (i.e., X number of days after notice of adverse benefit determination) in the event the TPA booklet/SPD doesn't clearly establish them, and state that such time limitations applies to CMS and Medicare.
2. Include a tack-on amendment for your wrap doc that says no waiver of such claim filling and appeal deadlines is permitted, and state that such ban on waivers applies to CMS and Medicare.