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CEBS; GBA Exam 3 questions and answers

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CEBS; GBA Exam 3 questions and answers

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CEBS GBA Exam 3 questions and answers

An employee welfare benefit plan has four basis elements. What are these elements?
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(Mod 1.1) - answer-1) There must be a plan, fund or program.
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2) The plan, fund or program is established or maintained by an employer.
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3) The plan, fund or program is for the purpose of providing specifically listed benefits,
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through the purchase of insurance or otherwise.
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4) Benefits are provided to participants and beneficiaries.
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Explain how a "plan, fund or program" for an employee benefit plan is defined (Mod 1.1)
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- answer-The phrase "plan, fund or program" is not defined in ERISA but rather has
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been laid out in several court cases. Courts have held a "plan, fund or program" under
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ERISA is established if, from the surrounding circumstances, a reasonable person can
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ascertain the intended benefits, the class of beneficiaries, the source of financing and
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the procedure to receive benefits.
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Describe the procedures required to establish an ERISA employee welfare benefit plan
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(Mod 1.1) - answer-No particular formalities are required to create an ERISA plan and
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no single action in and of itself necessarily constitutes establishment of ERISA
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employee welfare benefit plan. Thus, ERISA plans have been deemed to be
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"established or maintained" by a practice that would cause a reasonable EE to perceive
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an ongoing commitment by the ER to provide EE benefits. This would include any
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contributions by an ER toward payment of benefits or by the ER simply administering
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the benefit.
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It is easy to have a plan, fund or program - generally any ongoing administrative scheme
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cwill satisfy this condition. Showing that an ER maintains a plan is also easy - any
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ccontribution by the ER towards payment of benefits or administration of the plan is
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cenough (including a contribution toward insurance coverage).
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List the types of employee welfare benefit plans not covered under ERISA and
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specifically excluded under the statute (Mod 1.1) - answer-1) Governmental Plans:
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includes plans established by the US Gov't, the gov't of any state or political subdivision
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and any agency of any of the foregoing or a plan to which the Railroad Retirement Act
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applies, as well as certain plans associated with Native American Tribal gov'ts.
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2) Church plans: a plan established and maintained for its EE's by a church or by a
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convention or association of churches is exempt from tax under IRC Sec 501.
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3) A plan maintained to comply with state laws on Worker's Comp, Unemployment or
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Mandated Disability Insurance.
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4) A plan maintained outside the US primarily for nonresident aliens.
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5) Plans that cover only self-employed individuals and that cover no "common-law
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employees" generally not subject to ERISA.
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,6) Plans that cover only married shareholders of a corporation are not treated as ERISA
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plans.
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ER should be aware that is may be required to comply with other federal laws that affect
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EE benefit plans.
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List the types of benefits provided by ERISA health and welfare, and provide examples
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cof such plans (Mod 1.1) - answer-a) Medical, Surgical or Hospital Care or Benefits
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b) Benefits in the event of sickness, accident, disability, death or unemployment
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c) Vacation Benefits
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d) Apprenticeship or other training benefits
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e) Day-care centers
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f) Scholarship funds
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g) Prepaid legal services
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Ex: Medical Insurance, Dental, Vision, Prescription Drug Plans, Drug or Alcohol
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Treatment programs, FSAs, EAPs, Wellness Programs, AD&D and STD/LTD Plans.
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Discuss whether plans that involve payroll practices are treated as ERISA health and
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welfare plans (Mod 1.1) - answer-The payment of an employee's normal compensation
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in full or in part out of the
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employer's general assets for periods when the employee is physically or mentally
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unable to work—that is, an unfunded short-term disability plan—is generally not a
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welfare benefit plan subject to ERISA. However, if a disability program provides
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more than an employee's normal compensation or is funded in any way—for
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example, it is provided through insurance - the program will be a welfare benefit plan
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subject to ERISA.
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The Dept of Labor (DOL) regulations list additional types of payroll practices as not
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being ERISA plans. These include plans where compensation is paid to an EE:
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a) While absent on holiday/vacation
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b) While absent on active military duty
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c) While absent for jury duty/witness
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d) On account of periods of time during which the EE performs little or no work while in
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training
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e) EE is relieved of duties while on sabbatical leave or while pursuing further education.
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For a voluntary benefit arrangement to be exempt from ERISA based on the DOL safe
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harbor, it must meet certain requirements, which are? (Mod 1.1) - answer-a) No ER or
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EE organization contributions
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b) Participation is completely voluntary
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c) No ER consideration except for reasonable compensation and administration
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d) No employer endorsement
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,Explain the meaning of the term "no employer endorsement" (Mod 1.1) - answer-Means
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can ER can publicize, collect premiums, remit premiums, provide employee information
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cto an insurance company and maintain a
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file on the voluntary plan. However, an employer cannot express positive normative
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judgment and cannot urge/encourage employee participation. The participation of
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the employer or employee organization should be limited to the duties specified in
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the regulation, none of which involve the exercise of discretionary duties. An
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employer hoping to rely on this exemption should also be careful not to create the
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impression that the benefit is part of its benefit package by, for example, including it
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in enrollment materials or encouraging employees to enroll. DOL warns in the final
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Family and Medical Leave (FMLA) regulations that if a plan is intended to be
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exempt from ERISA under this provision, the ER should not pay an EE's premium while
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cthe EE is on FMLA leave.
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Define each of the following ERISA terms:
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a) plan administrator/sponsor
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b) participant
c


c) beneficiary (Mod 1.2) - answer-(a) Plan administrator/plan sponsor
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A plan administrator is a person with statutory responsibility for ensuring that all of the
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crequired filings with the federal government are timely made and is the person upon
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cwhom the statute imposes authority to make important disclosures
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to participants about plan benefits. Generally, the plan administrator is designated in the
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cplan document. However, if the plan administrator is not so designated, then the
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cresponsibility defaults to the plan sponsor, which is usually c c c c c c c c


the employer. Generally, in a single employer situation, the employer is the plan
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csponsor. Therefore, the employer is ultimately responsible for all reporting and
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cdisclosure requirements and should implement a process to make certain those
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cresponsibilities are followed. c c




b) Participant:
c


The term participant has been interpreted broadly to include employees in, or
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reasonably expected to be in, currently covered employment. This would include
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employees who are eligible for a plan but who are not enrolled. However, employees in
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a class not eligible to participate in a plan are not participants
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under the ERISA definition. In addition, because the definition is not limited to current
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employees, it can include COBRA-qualified beneficiaries, covered retirees and other
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former EE's who may remain eligible under a plan.
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(c) Beneficiary:
c


A beneficiary is any person designated by a participant (or by the terms of an ERISA
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cplan) who is or may become entitled to a benefit under the plan. A beneficiary has rights
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cprovided under the plan in question, and the plan
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fiduciaries owe fiduciary duties to plan beneficiaries as well as to plan participants. A
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cbeneficiary may sue under ERISA for plan benefits and to remedy ERISA violations. A
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cbeneficiary also has the right to examine and c c c c c c c


request copies of plan documents. c c c c

, What are the main disclosure requirements under ERISA? (Mod 1.2) - answer-(a) A plan
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cdocument must exist for each plan c c c c c


(b) A summary plan description (SPD) must be furnished automatically to participants
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(c) A summary of material modifications (SMM) must be furnished automatically to
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cparticipants when a plan is amended c c c c c


(d) A four-page summary of benefits and coverage (SBC) must be provided to applicants
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cand enrollees before enrollment or reenrollment
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(e) Copies of certain plan documents must be furnished to participants and beneficiaries
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cupon written request
c c


(f) Claim procedures must be established and followed when processing benefits claims
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cand when reviewing appeals of denied claims
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What are the main requirements that pertain to ERISA plan assets? (Mod 1.2) - answer-
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a) Plan assets, including participant contributions, may be used only to pay plan benefits
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and reasonable admin costs.
c c c c


b) For some plans, plan assets may have to be held in trust.
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c) A fidelity bond must be purchased to cover every person who handles plan funds.
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Define plan document and explain why it is vital to meet the written document
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requirement (Mod 1.2) - answer-ERISA requires that every ERISA health and welfare
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plan be established and maintained in writing, and the scope of an ERISA plan is
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defined by the official plan document. The plan document describes the plan's terms
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and conditions related to the operation and administration of a plan. An insurance
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company's master contract, certificate of coverage or summary of benefits is usually not
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sufficient to serve as a legal plan document and rarely fully protects the plan sponsor.
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Every plan participant has the right to examine the plan document.
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What specific liabilities or problems exist for an ER that fails to have a plan document?
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c(Mod 1.2) - answer-An ERISA plan may still exist even w/o a written plan document. A
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cplan administrator's failure or refusal to put a plan in writing is merely a violation of
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cERISA and does not avoid coverage of the plan by ERISA. Failure to have a plan
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cestablished in writing can result in the following liabilities or problems for the
c c c c c c c c c c c c


employer:
(a) Participants and beneficiaries may bring suit to enforce the ERISA written plan
c c c c c c c c c c c c


cdocument requirement. Legal action may require the preparation of a formal document
c c c c c c c c c c c


cwhere none currently exists.
c c c


(b) A plan document must be furnished in response to a participant's written request.
c c c c c c c c c c c c c


cThe plan administrator may be charged up to $110 per day if the document is not
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cprovided within 30 days of a request.* c c c c c c


(c) Criminal penalties may be imposed on any individual or company that willfully
c c c c c c c c c c c c


cviolates any requirement of Title I of ERISA, which includes disclosure rules. The
c c c c c c c c c c c c


cpenalty per conviction could be $100,000 and/or imprisonment for up to ten years. The
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cfine can be increased up to $500,000 if it is against a company.
c c c c c c c c c c c c


(d) It can be difficult to prove plan terms and thus enforce plan provisions.
c c c c c c c c c c c c c


(e) Participants and beneficiaries who sue to enforce informal, unwritten plans can
c c c c c c c c c c c

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