TriSure Education Series: ERISA Basics

Here are the top five things TriSure’s team took away from the seminar:

1. What constitutes an ERISA plan
   
   There are five elements to an ERISA program:
   1. Plan / fund or program
   2. Established or maintained
   3. By an employer or employee organization or both
   4. Exist for the purpose of providing welfare or retirement benefits
   5. to participants and beneficaries.
   
   
2. Employer responsibilities
   
   ERISA requires the disclosure of certain information about the welfare benefit plan:
   
   • Plan documents
   • Summary Plan Description (SPD)
   • Summary of Material Modification (SMM)
   • Summary Annual Report (SAR).
   
   All of these documents must be furnished in a way “reasonably calculated to ensure actual receipt by all partipants covered under the plan.”
   
   Approved methods include US Mail, special insert in company publication and in–hand delivery. SPDs and SMMs can be delivered electronically.
    
   
3. Reporting requirements
   
   
   • Form 5500
   • Schedule A
   • Schedule C
   
   
4. Employers who qualify for ERISA
   
   The ERISA law stipulates that plans covering at least one person are subject to the ERISA regulations. Additionally, form 5500 is only required for health and welfare plans who have a least 100 subscribers.
    
   
5. Participant and claimant rights
   
   Disclosure and Reporting, (SPD, SMM, SAR), Benefit Determinations,(Timing, Notice, Appeals) A ERISA welfare benefit claim is a request for benefits, by a claimant, in accordance with the plans reasonable procedure.
   
   There are four basic steps to the ERISA Claims procedure:
   1. Submision
   2. Determenination
   3. Appeal
   4. Review