Employee Benefit Plan Requirements

Even if you go through an insurance broker for your company’s health and employee benefit plans, it’s a good idea to have an understanding of the requirements held by ERISA as well as the benefits they cover.

Benefits Covered by ERISA

medical, surgical, or hospital care

benefits for sickness, accident, disability, or death

unemployment benefits

vacation benefits

apprenticeship and training programs

day care centers

scholarship funds

prepaid legal services

holiday or severance pay

retirement plans

Administrative Requirements Set and Regulated by ERISA

Plan administrators are required to file specific informational returns. These must be filed with the Department of Labor and the IRS. When filed, a summary plan and description of the coverage levels and claim procedures in the plan.

Plan administrators are required to share information with individuals covered by the plan. Administrators are also required to report to the Department of Labor upon request. Participants will receive a wide range of information on coverage levels and financial information.

Welfare plans covered by ERISA must establish a claims procedure to process claims for benefits. When a participant is denied benefits, the plan is to provide further information to that participant.

If you are under an insurance contract, you are obligated to distribute plan information to all employees. This information must be given by the time the plan goes into effect or during an employee’s orientation. Always be sure that your insurance broker or agent is in compliance with the ERISA requirements.