Nearly every business is subject to ERISA which specifically requires that an employee benefit plan, including a welfare benefit plan, be established in writing.
- See ERISA Compliance Checklist
- If any questions are “No”, then consider retaining a labor law attorney or a TPA offering compliance services.
Deliver Summary of Benefits and Coverage (SBC) Documents
Deliver at enrollment, renewal, and to new hires.
- Usually available online in Carrier's Employee Portal
- Usually mailed by Carrier to Employee.
Explain ACA-mandated essential health benefits
- This information is usually included in an SBC.
- The Affordable Care Act requires non-grand-fathered health plans in the individual and small group markets to cover essential health benefits (EHB), which include items and services in the following ten benefit categories: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric services, including oral and vision care.
Summary Plan Description (SPD)
- This document is not the same as an Summary of Benefits and Conditions and must be prepared separately. Your carrier probably is not preparing this document for you.
- Best practice is to distribute to employees at hire and annually thereafter.
- ERISA requires that SPDs be supplied to participants in a method “reasonably calculated to ensure actual receipt of the materials."
- Document needs to be updated when the described plans change.
- An employer may attempt to create their own SPD https://www.dol.gov/general/topic/health-plans/planinformation, or retain a TPA offering the service, or contact an employment law attorney.
- All plans that are subject to ERISA (health, dental, vision, group life, Rx, sickness/accident, FSA, HRA, etc.) need to be included in an SPD.
This document provides a general overview of the different compliance aspects in regards to ERISA to all employers are subject to. There are required notices that are not covered in this piece, however, the Department of Labor created a Reporting and Disclosure Guide for Employee Benefit Plans that covers most of the required notices.