News
Department of Labor Increases Penalties for Health Plan Violations
– info from Zywave
On July 1, 2016 the Department of Labor issued an interim final rule that increases the civil penalty amounts that may be imposed under various federal laws. The interim final rule increases the civil penalty amounts associated with:
- Failing to file an annual 5500 (as applicable);
- Failing to provide annual notice regarding premium assistance under the Children’s Health Insurance Program (CHIP); and
- Failing to provide the Summary of Benefits and Coverage (SBC), as required by the Affordable Care Act (ACA).
The increased amounts apply to civil penalties that are assessed after August 1, 2016, for violations that occurred after November 2, 2015.
|
Requirement |
Current Penalty Amount |
New Penalty Amount |
|
Failure to file an annual report (Form 5500) with the DOL |
Up to $1,100 per day |
Up to $2,063 per day |
|
Failure of a multiple employer welfare arrangement (MEWA) to file an annual report (Form M-1) with the DOL |
Up to $1,100 per day |
Up to $1,502 per day |
|
Failure to furnish plan-related information requested by the DOL |
Up to $110 per day, not to exceed $1,100 per request |
Up to $147 per day, not to exceed $1,472 per request |
|
Failing to provide the annual notice regarding CHIP coverage opportunities |
Up to $100 per day for each failure |
Up to $110 per day for each failure |
|
Failure to timely disclose information to a state regarding group health plan coverage of an individual who is covered under a Medicaid or CHIP Plan |
Up to $100 per day for each participant/violation |
Up to $110 per day for each participant/violation |
|
Failure by any health plan sponsor to comply with the requirements of the Genetic Information Nondiscrimination Act (GINA) for health plans |
$100 per participant per day Minimum penalty of $2,500 per participant for de minimis failure prior to notice Minimum penalty of $15,000 per participant for non de minimis failure prior to notice $500,000 cap on unintentional failures |
$110 per participant per day Minimum penalty of $2,745 per participant for de minimis failure prior to notice Minimum penalty of $16,473 per participant for non de minimis failure prior to notice $549,095 cap on unintentional failures |
|
Failure to provide Summary of Benefits and Coverage (SBC) |
Up to $1,000 per failure to provide the SBC |
Up to $1,087 per failure to provide the SBC |