CLEVELAND--(BUSINESS WIRE)--aequum LLC, serving over 425 self-insured health plans and their participants nationwide, announced today the critical need for plan sponsors to understand and comply with ERISA regulations in order to maintain the tax advantages and benefits of employer-sponsored health coverage. Plan sponsors are encouraged to follow and share the Department of Labor’s (DOL) Fiduciary Responsibilities Guide which includes comprehensive guidance.
“Our team strongly recommends that plan sponsors carefully review this guidance and conduct periodic internal audits to ensure and document compliance with the terms of their plan documents, ERISA and tax code requirements,” says Christine Cooper, CEO, aequum. “Compliance with ERISA and its fiduciary responsibilities is non-negotiable - necessary to protect both the plan and its participants from potential legal challenges.”
Employer-sponsored health plans benefit from federal and state income tax preferences, as well as FICA and FICA-Med tax preferences, allowing contributions towards coverage and out-of-pocket expenses to be significantly reduced, often by 25% to 33%. To maximize these savings, aequum suggests implementing superior plan design features like Health Savings Account (HSA)-capable coverage and Reference-Based Pricing coupled with effective participant representation services.
The DOL publication covers important topics:
- Essential Elements of a Plan: Written plan documents, trust requirements, recordkeeping systems and mandated disclosures.
- Requirements When Hiring Service Providers: Fiduciary decisions, provider comparisons and performance monitoring.
- Fiduciary Duties: Discretionary authority, plan implementation, risk minimization and acting in the best interest of participants.
- Settlor Duties: Plan establishment, benefit determination and plan amendments.
- Fidelity Bond: Insurance to protect against fraud and dishonest acts.
- Worker Contributions: Timely remittance to the plan or trust.
- Fees: Ensuring third-party compensation is reasonable.
- ERISA Claims and Appeals Process: Compliance with minimum standards, criteria for care and disclosure requirements.
- Recissions of Coverage: Retroactive cancellation protocols.
- External Review Requirement: Third-party engagement post-claims process
- Prohibited Transactions: Civil and criminal penalties for non-compliance.
- Mandated Disclosures/Notices: Various required communications, including SPDs, SBCs and COBRA notifications.
- Government Reporting: Form 5500 annual reports.
- Qualified Medical Child Support Orders (QMCSO): Compliance with private or state agency orders.
About aequum LLC
Founded in 2020, aequum LLC serves third-party administrators, medical cost management companies, stop-loss carriers, employer-sponsored health plans, and brokers nationwide to protect plan participants, improve employee satisfaction with their healthcare plans, and generate plan and participant cost savings. aequum LLC helps patients defend against medical balance bills and provides administrative services to its partners. Its sister organization, Koehler Fitzgerald LLC, offers legal advocacy to plan participants. Visit aequumhealth.com.
