BASE® ERISA Wrap
BASE® ERISA Wrap is designed to help employers fulfill the ERISA requirements for an SPD and Plan Document. Many employers mistakenly assume that insurance contracts, certificates of insurance and benefits summaries fulfill the ERISA requirements for an SPD and Plan Document – but they don't include the required or recommended provisions that protect the plan and the employer from $110 per-day, per-employee penalty.
BASE® ERISA Wrap has been developed together with a major ERISA law firm that makes it easy and economical to comply with federal requirements.
BASE® will provide you with a Wrap SPD and Wrap Plan Document which are designed to wrap around existing certificates of insurance and benefit plan booklets to provide the required provisions and information necessary to comply with ERISA. To be compliant, the Wrap SPD and accompanying benefit plan component documents must be distributed to plan participants.Benefits
- Distribution guidelines that explain how and when to provide these compliance documents to your plan participants.
- The ability to keep your documents current and updated should the federal government issue new amendments or if plan information needs to be changed.
ERISA & ACA Compliance Service Package
Outside of preparing and creating customized Plan Documents and Summary Plan Descriptions, BASE® will also provide added ERISA and ACA compliance documentation and distribution guidelines. Plus, this plan documentation includes all required salary reduction information when applicable in the form of a Premium Only Plan. Our complete package includes:STANDARD WRAP COMPLIANCE SERVICES
- Disclosure of Grandfathered Health Plan Status
- Dependent Coverage to Age 26
- Pay or Play
- Medical Loss Ratio
- Women's Health & Cancer Rights Act
- Newborns' & Mothers' Health Protection Act
- Summary of Material Modifications (SMM)
- Includes all required salary reduction information
- Outlines benefits offered on a pre-tax basis, if any
- Keeps salary reduction and insurance information in same document for complete wrap around plan administration
- Notice of Patient Protections
- Notice of Coverage Options
- Children's Health Insurance Program Reauthorization Act (CHIPRA)
- Wellness Program Disclosure
- HIPAA Special Enrollment Rights Notice
Frequently Asked Questions
All ERISA-covered benefit plans, including group health plans and other welfare plans, must, by law, be administered in accordance with a written plan document. ERISA, HIPAA and other federal laws require the plan document to contain certain specified provisions. Many employers assume that insurance contracts for fully insured products are written plan documents. Insurance companies, however, draft their contracts to comply with state insurance laws and, as a result, the contracts do not contain many of the required or recommended provisions that protect the plan, the employer and plan fiduciaries.
A Wrap Plan Document is designed to meet plan documentation requirements under ERISA and other federal laws and to incorporate all other welfare plans, insurance contracts and other relevant documents into a single plan. These materials can be kept together for administrative ease. The Wrap Plan Document provides additional legal protection for the employer and plan fiduciaries and can simplify plan administration.
ERISA is a federal law that covers most private sector employee benefit plans, and which sets forth uniform minimum standards to ensure that such plans are established and maintained in a fair and financially sound manner. Among other things, ERISA requires plan administrators—the people who run plans—to give plan participants in writing the most important facts they need to know about their health benefit plans including plan rules, financial information, and documents on the operation and management of the plan.
One of the most important documents participants are entitled to receive automatically when becoming a participant of an ERISA-covered health benefit plan or a beneficiary receiving benefits under such a plan, is a summary of the plan, called the summary plan description or SPD. For other basic disclosure requirements under ERISA, please refer to the U.S. Department of Labor’s Reporting and Disclosure Guide for Employee Benefit Plans.
No. While carriers do provide plan information, they typically will not provide the required provisions that must be included in an SPD and plan document. So an employer/plan administrator will not be in compliance and faces the risk of penalties and other complications if participants only receive a benefits booklet/summary or certificate of insurance.
The plan administrator (which is typically the employer) is the person specifically designated by the terms of the plan who is responsible for its management. If the plan does not make a designation, the plan sponsor (typically the employer that establishes or maintains the plan) is generally the plan administrator.
The SPD should be distributed automatically to all plan participants. The employer/plan administrator also must furnish copies of the most current SPD and plan document to participants and beneficiaries upon written request and must have copies available for examination. Copies should be furnished no later than 30 days after a written request.
Employers/plan administrators may be liable for serious penalties if they don't provide an SPD or have a current plan document:
- Failure to provide an SPD or plan document within 30 days of receiving a request from a plan participant or beneficiary can result in a penalty of up to $110/day per participant or beneficiary for each violation.
- Lack of an SPD could trigger a plan audit by the U.S. Department of Labor (DOL).
- Having documentation in order protects against disgruntled employees if issues regarding coverage arise.
Ultimately it is up to the employer to determine what constitutes a Government agency or Church group, as not all agencies or groups qualify for these exemptions. Below are some general guidelines to follow in determining the proper designation.
ERISA defines a governmental plan as any employee benefit plan established or maintained by the government of the United States, by the government of any state or political subdivision thereof, or by any agency or instrumentality of any of those.
While it has not been specifically addressed in the statue or regulations, courts have held that a plan established by a state sponsored public school or school district would constitute a governmental plan.
ERISA defines a church plan as a plan that is established or maintained for its employees (or their beneficiaries) by a church or by a convention or association of churches that is exempt under IRC Section 501.
Whether the church is exempt under IRC Section 501 would depend of whether the church has received an Internal Revenue Service determination letter stating that the church is 501 exempt. The church must not have made an irrevocable election under IRC Section 410(d). If the church has made such an election, then plan is subject to all of ERISA’s requirements by virtue of the election.
Nonprofits (501c-3) do not have an exemption under ERISA. They will need to have an ERISA Wrap Plan if they have any benefits.