Dear Valued Client/Partner,

Effective February 27, 2017, we have incorporated the following revisions into our templates:

Plan Document and SPD:

  1. Updated definition of HIPAA-excepted benefit to incorporate DOL, HHS and Treasury Department final regulations
  2. Added MLR Premium Holiday language
  3. Enhanced subrogation language
  4. Enhanced general claims procedure, special rules for group health plan claims, and disability claims language
  5. Removed external appeals table and added web link to HHS for real time updates
  6. Updated CHIP funding language
  7. Added acknowledgement of third-party COBRA administrators in COBRA section
  8. Added carryover language to COBRA section dealing with FSAs
  9. Updated GINA section to comply with EEOC final rule issued May 17, 2016
  10. Specified coverage until the end of the calendar month in which a child turns 26 in compliance with ACA
  11. Updated out-of-pocket maximum of essential health benefits for 2017
  12. Added new language to Exhibit/Appendix B if “No” is chosen in WT for look-back language to allow for a situation where an employer has look-back language but does not wish to disclose it in their wrap plan

Plan Document Only:

  1. Added Special Rule to look-back language

SPD Only:

Clarified potential for third-party administrator of self-funded plan to accept claim fiduciary status (mirrored language already in Plan Document)
Added process to USERRA language for returning to work and receiving coverage while on leave
Updated Wellness section to comply with EEOC final rule issued May 17, 2016
Updated with increased penalty for failure to provide Plan documents

Model Notice Package:

  1. Updated CHIP notice
  2. Added EEOC Wellness Program Notice

These improvements to the Wrap Plan and SPD do not require immediate distribution to your employees. We recommend updating your Plan Document and SPD annually to capture any employer, plan or benefit changes that may have occurred during the year, and these improvements along with your other changes will automatically be incorporated into that update.

With continued health care reform promised by our Congressional leadership, it is inevitable that many changes are on the way. Your renewal subscription helps you maintain ERISA-compliant disclosure documents, reducing problems with the DOL. And more importantly today than ever, these updates should help minimize an employer’s potential legal liability to possibly confused and disgruntled plan participants.

We at ERISA Pros are committed to timely distributing any necessary updates and required modifications in this constantly-evolving area of the Federal law.