Agenda

Overview

• What Is A Cafeteria Plan?
• Tax Savings
• Employer Benefits
• Who May Establish A Cafeteria Plan?
• Understanding Cafeteria Plans
• Basic Advantages Of Cafeteria Plans
• Basic Disadvantages Of Cafeteria Plans

Eligible Benefits

• Eligible Benefits: Introduction
• Eligible Benefits
• Health Care Premiums
• Individual Insurance Policies
• Health Flexible Spending Arrangements (HFSAs)
• HFSA Requirements
• Group Term Life Insurance: Coverage In Excess Of $50,000
• Income Replacement
• Vacation Buy/Sell Arrangements
• Buying Of Vacation Days
• Selling Of Vacation Days
• Section 401(k) Plans
• Adoption Assistance Benefits/Adoption Assistance Credit
• Dependent Care Assistance Programs
• Group Term Life Insurance

Eligible Expenses

• Eligible Expenses: Premium Only Plans
• Eligible Expenses: Health Flexible Spending Arrangement (HFSA)
• Examples of Eligible HFSA Expenses
• Eligible Expenses: Dependent Care Assistance Programs
• Ineligible Expenses: Premium Only Plans
• Ineligible Expenses: Healthcare Flexible Spending Arrangements
• Ineligible Expenses: Dependent Care Assistance Programs
• Ineligible Expenses: Life Insurance

Eligible Participants

• Common Law Employees
• Former Employees: Severance Agreements
• Leased Employees
• Other Relationships
• Affiliated Service Groups
• Plan Participation Eligibility Criteria
• Why Implement Eligibility Rules?
• Definition Of Employees
• Former Employees: Retirees
• Partners, Independent Contractors, 2% Or More Owners

Governance

• Sources Of Cafeteria Plan Law
• ERISA
• Evolution Of Cafeteria Plans
• Obtaining IRS Information: Private Letter Rulings
• Obtaining IRS Information: Information Letters
• Obtaining DOL Information Letters
• Obtaining DOL Information: Advisory Opinions
• IRS Audits
• DOL Audits

Design Options

• Cafeteria Plan Designs
• Premium Conversion Plans
• Flexible Spending Arrangements (FSAs)
• Health Flexible Spending Arrangement
• HFSA Design Requirements
• HFSA Contributions
• The "Use-It-Or-Lose-It" Rule
• HFSA Reimbursements
• Dependent Care FSAs
• Dependent Care FSAs Design Requirements
• Dependent Care FSAs Limits
• Core-Plus
• The Fully Flexible Cafeteria Plan
• Flexible Benefit Credits
• Opt-Out Feature
• Health Reimbursement Arrangements (HRA)
• Differences Between HRAs And HFSAs
• Claims Submission And Reimbursement: The Run-Out Period
• Plan Assets: Premium Conversion Plans
• Plan Assets: Health Flexible Spending Arrangements
• Plan Assets: Dependent Care Assistance Plans
• Plan Assets: Core Plans And Fully Flexible Cafeteria Plans
• Fiduciary Responsibilities

Plan Documentation & Communication

• Plan Documentation & Communication: Introduction
• Master Plan Document
• Distribution Of The Master Plan Document
• Summary Plan Descriptions: Required Content
• Summary Plan Descriptions: Style And Format
• Summary Plan Descriptions: Distribution & Disclosure Requirements
• Summary Plan Descriptions: Reporting Requirements
• Summary Plan Descriptions: Summary Annual Report
• Employer Responsibilities
• Plan Communications
• Summary Plan Descriptions
• Salary Reduction Agreements

Election Options

• Annual Election Requirement
• Positive Election
• Default Election
• Correcting Election Errors
• Irrevocable Elections Requirement
• New Hires
• Election Options For A POP
• After-Tax POP: Advantages And Disadvantages
• Employer Plan Contributions
• Plan Year
• Automatic Election
• Written Forms
• Online
• By Telephone

Status Changes

• Permissible Status Changes
• Change In Employment
• Change In Employment: Rehires
• Change In Residence
• Change In Marital Status
• Change Of Dependent Status
• Change In Number Of Dependents
• Adoption Assistance
• Significant Cost Or Coverage Changes
• Coverage Changes: Own Employer
• Coverage Changes: Other Employer-Sponsored Plan
• Health Flexible Spending Arrangements
• Dependent Care Assistance Programs
• Medicare/Medicaid And Other Government Health Programs
• HIPAA Special Enrollment
• FMLA Leave
• Judgment/Decree/Order
• “Consistency” Rule
• Timing Of Changes
• Receiving, Processing, And Handling Status Changes

Claims Submittal Options & Procedures

• Where And How Claims Should Be Submitted
• Time Frame For Submitting Claims
• Submitting Claims: Written Forms
• Submitting Claims: Debit Cards
• Submitting Claims: Health Insurance Company Automatic Reimbursements
• Submitting Claims: Pre-Approved Annual DCAP Expense Form
• Claims Dispute Options & Requirements

Reimbursement Options & Procedures

• Checklist For Processing Claims
• DOL Requirements
• IRS Requirements
• Reimbursable Expense Analysis: HFSAs
• Reimbursement Options
• Reimbursement Must Be For An Eligible Expense
• Expense Must Be Incurred In An Eligible Time Period
• Reimbursement Claims Must Be Made In A Timely Fashion
• “Run-Out” Periods
• Minimum Reimbursement Requirements
• Deferral Of Compensation
• No Commingling Amongst FSA Accounts Or Payment Of Insurance Premiums From An FSA.
• Receiving Submitted Claims For Reimbursement
• Processing Claims: HFSA Reimbursement Requests
• Processing Claims: Invalid HFSA Reimbursement Requests
• Processing Claims: Valid HFSA Reimbursement Requests
• Processing Claims: Insurance Company Automatic Reimbursements
• Special HFSA Issue: Orthodontia
• Special HFSA Issue: Capital Expenses
• Dependent Care FSA Reimbursement Options
• Processing Claims: Dependent Care Assistance Plans (DCAPs)
• Processing Claims: Verification Of DCAP Claims
• Reimbursements Paid By Mistake

Other Administrative Issues

• The “Use-It-Or-Lose-It” Rule
• Forfeitures
• Uniform Coverage Rule
• Administrative Issue: Dependent Care Assistance Programs
• Administrative Issue: Dependent Care Assistance Programs Claims
• Employer/Plan Responsibility

Integration With Other Laws

• Interaction With HIPAA
• Interaction With COBRA
• COBRA and POP Plans
• COBRA and HFSAs
• COBRA and DCAPs
• Interaction With FMLA
• Cafeteria Plans During Leave
• FMLA: Reinstatement To Equivalent Benefits
• FMLA: Proration Rule
• FMLA: Required Reinstatement To Equivalent Benefits
• FMLA: Catch-Up Option

Discrimination Testing Overview

• Discrimination Testing Overview
• Reasons For Testing
• Preparation For Discrimination Testing
• Discrimination Tests For Self-Insured Medical Plans (Including HFSAs)
• Testing Universe
• Excludable Employees
• Eligibility Test
• Nondiscriminatory Classification Test
• Nondiscriminatory Classification Test: Safe Harbor Percentage Test
• Safe Harbor Test: IRS Comparison Table
• Nondiscriminatory Classification Test: Fair Cross-Section Test
• The Benefits Test
• Discrimination Testing: Key Employees
• Disability Insurance
• Premium Only Plans
• Dependent Care Assistance Programs Overview
• Dependent Care Assistance Programs Nondiscrimination Requirement
• Dependent Care Eligibility Requirement
• Dependent Care Contributions And Benefits Test
• The 55% Average Benefits Test
• Concentration Of Benefits Test (The 25% Test)
• Plan Design
• Adoption Assistance Programs Discrimination Testing
• Cafeteria Plan Testing
• The Three Cafeteria Plan Discrimination Tests
• HCE Eligibility Test
• HCE Contributions and Benefits Test
• Actual Operation
• 25% Key Employee Concentration Test
• 25% Key Employee Concentration Test Example

Reporting & Disclosure

• DOL Requirements
• IRS Requirements
• Other Plan Documents

Regulations

• Links To Government Sites And Posted Regulations