Top Things You Need to Stay in ERISA Compliance

First tool that you need to have for ERISA Compliance is your Plan Documents:

  • Summary Plan Description (SPD’s)
  • Summary of Material Modifications
  • Plan Document – including amendments
  • All fully-insured plan contracts
  • Trust Documents
  • Responsibilities of employer and employee associated with the costs of health and welfare benefits
  • Form 5500 filings (if applicable)
  • Summary of Annual Reports for plan years

In addition to your Plan Documents, you need to cover the following bases for complete ERISA Compliance:

  1. Checklist of Requested Documents Maintained by Employer
  2. Plan document (or insurance booklet/certificate for an insured plan)
  3. Summary plan description (SPD), including updates or summaries of material modifications (SMMs) Forms 5500 and attachments, including supporting documentation (if applicable)
  4. Summary annual reports (if required for plan)
  5. List of all plan service providers and related contracts
  6. All contracts with insurance companies
  7. Open enrollment materials, including documents describing cost responsibilities for the employer and employees
  8. Newborns’ and Mothers’ Health Protection Act notice (may be included in the SPD)
  9. Women’s Health & Cancer Rights Act notice
  10. Annual Children’s Health Insurance Program (CHIP) notice
  11. Documents showing compliance with HIPAA’s portability rules, including certificates of creditable coverage, pre-existing condition exclusions and special enrollment rights
  12. Documents showing compliance with COBRA, including general notice, election notice, notice of COBRA unavailability, notice of early termination and notice of insufficient payment
  13. If the plan has grandfathered status under the ACA, documents that verify the plan’s status and the notice of grandfathered plan status I
  14. f the plan has rescinded coverage, a list of those participants and dependents whose coverage has been rescinded, the reasons for the rescission and the notice of rescission
  15. Plan provisions regarding lifetime and annual limits and the notice describing enrollment opportunities for individuals who previously lost coverage due to a lifetime limit
  16. Summary of Benefits and Coverage and any 60-day advance notice of a mid-year material change to the plan
  17. Exchange notice
  18. For non-grandfathered plans, notice of patient protections and selection of providers
  19. For non-grandfathered plans, information on the plan’s claims and appeals procedures
  20. A notice describing enrollment opportunities for children up to age 26 for plans with dependent coverage

 

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