The Employee Retirement Income Security Act of 1974 (ERISA) was enacted to protect the interests of individuals who participate in an employer-sponsored group health, pension, and benefits plan. To ensure that these interests are upheld, certain requirements are in place for all plan sponsors and administrators to follow in order to meet their ERISA obligations.
It is a common misnomer that ERISA only applies to self-funded plans. ERISA applies to all employee benefit plans, self-insured and fully insured, regardless of size. This is why it is essential for plan administrators to understand the importance of ERISA, and take the necessary steps to stay in compliance to avoid possible penalties by the Department of Labor (DOL). See the More Info Section below to see to which types of plans ERISA applies, and which employers are exempt.
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What are the ERISA requirements for an Employer-sponsored Health Plan?
- Written Plan Document – insurer certificates are not sufficient; a wrap document is often required
- Summary Plan Descriptions (SPDs)
- Summary of Material Modification (SMM) for off-anniversary changes
- Form 5500 and Summary Annual Report (SAR), for those with 100+ participants
- Numerous required notices throughout the year – note that these changed recently
- COBRA compliance
- HIPAA and HITECH compliance – including the latest privacy regulations effective 9/23/13
- Medicare Part D notifications to members and CMS if any beneficiaries could be Medicare eligible; note that even some non-ERISA plans such as churches and governments are also subject to this requirement
Once you have the above pieces in place (the Fall River ERISA Toolkit can help), we recommend an annual checkup where once a year you:
- Collect and review all benefit plan documents
- Identify plan changes and initiate corrections
- Mark calendar for the dates required forms are due and deadlines for reporting
- Review and update required notices for employee distribution
Fall River understands the complexity of ERISA and feels it is important for employers big and small to know the “who, what and when” of ERISA compliance. If this is an area where you need some help getting fully into compliance, just This email address is being protected from spambots. You need JavaScript enabled to view it. or give us a call at (303) 369-3200!
The information provided only gives a brief summary and general guidance, and should not be considered legal advice. We always recommend you contact your ERISA attorney regarding the laws and regulations that interpret your health plan.
MORE INFO:
What plans are subject to ERISA?
- Group Medical (PPO, HDHP, HMO, POS, etc.)
- Dental
- Vision
- Group Life & AD&D
- Disability
- Prescription Drug Plans
- FSA
- HRA
- Wellness programs (if medical care is offered)
- Employee Assistance Programs (if counseling is provided)
What types of employers and plans are NOT subject to ERISA?
- Government Plans (federal, state, city, county, public school districts)
- Church
- Health Savings Accounts themselves (though the underlying HDHP plans are)
- Section 125 - Premium Only Plans
- Payroll Practices
- Voluntary Plans
