Benefits Compliance FAQs
Some of our most frequently asked Benefits Compliance questions:
What is a Summary of Benefits and Coverage (SBC)
An SBC is an easy-to-read benefit outline that lets you make apples-to-apples comparisons of costs and coverage between health plans.
What is Open Enrollment?
Open enrollment is a period of time each year when employers permit employees to enroll in benefits or make changes to their benefit elections. Open enrollment is an excellent time to help your employees understand and appreciate the substantial value of their benefits.
What is an ERISA plan?
The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for employee health plans maintained by private-sector employers. These include corporations, partnerships, limited liability companies, sole proprietorships, and nonprofit organizations.
ERISA requires plans to provide plan information about features and funding. It also requires plans to establish a grievance and appeals process for participants to receive benefits. ERISA provides fiduciary responsibilities for those who manage and control plan assets. Finally, ERISA gives participants the right to sue for benefits and breaches of fiduciary duty.
Who is the Plan Administrator?
The plan administrator has the authority and responsibility to manage and direct the operation and administration of your Group Health Plan. The plan administrator is specifically designated by the terms of the plan. If the plan does not make such a designation, then the plan sponsor is generally the plan administrator.
What is a Summary Plan Description (SPD)?
An SPD is a laymen’s description of all provisions of a Group Health Plan. It is required to be distributed to participants and beneficiaries under the requirements of ERISA and DOL regulations. It is not the responsibility of the insurance carrier to draft an SPD or distribute it to participants and beneficiaries.
Who is the Plan Sponsor?
The plan sponsor is an employer, when acting in its role of implementing, or adopting, amending, terminating or funding a Group Health Plan.