Some of you may be familiar with ERISA (Employee Retirement Income Security Act), some of you may think it only applies to large groups. It is the “buzz topic” right now in the benefits industry and in the forefront of brokers and employers for several reasons. One reason it is in the forefront is due to Healthcare Reform and its funding. The DOL has hired new auditors to begin looking at health plans to be sure that they are compliant with ERISA. No matter what size employer you are, this part of ERISA applies to you.
One of the things that makes a plan compliant is the yearly distribution of an SPD (Summary Plan Description) to each eligible employee. This document is separate and different from the SBC (Summary of Benefits Covered) that you get from your carrier. The SPD is a much more comprehensive document that includes your health plan information, but can also include information about other benefits you offer your employees as well. You can incur fines for failure to provide this document.
Another reason ERISA is in the forefront is because some medical providers, in particular hospitals, are using ERISA compliance as a way to get additional payments on claims. They are mailing letters to employers saying they are working on behalf of a particular employee and asking for a copy of the SPD. Please note that you are NOT required to give an SPD to a provider. SPDs are for distribution to your employees. Also note that your employee may be completely unaware that the provider is sending this letter on their behalf.
Should you receive one of these letters from a provider requesting an SPD on behalf of an employee or if you get something from the DOL regarding ERISA compliance. Don’t panic! Give us a call to go over what you have received and help you plan a course of action. We have partners we are working with to help our clients get ERISA compliant and we can talk to you about your best options.
If you do not receive any of these letters, but are interested in further information, please let us know.Share