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ERISA applies to health and welfare plans as well as to retirement plans. However, since its enactment, the predominant focus of ERISA related regulatory activity, plan sponsor compliance and litigation has been on retirement plans. The period following the enactment of the Affordable Care Act has seen a growth in awareness of ERISA: (i) health plan related compliance requirements; as well as (ii) fiduciary provisions, and liability for failure to comply, applicable to:
- health plan sponsors;
- decisions (“inadvertent fiduciary”) involving health plan operations;
- plan service providers including insurers and PBMs; and
- utilization of sponsor services or products.
Accordingly, the intent of this program is to provide an overall review of the range of ERISA considerations (and Code provisions) applicable to this health plan, from documentary compliance through:
- health plan operations issues;
- determining whether producers of medical products or services or providers of insurance or other services, are fiduciaries and subject to ERISA’s prohibited transactions provisions; and
- conflict of interest/prohibited transaction considerations when plan sponsors provide services/products to their health plan covered employees.
Program Level: Overview
Intended Audience: In-house counsel, outside attorneys and other allied professionals who advise on ERISA, and Health and Welfare plans.
Prerequisites: An interest in how core ERISA compliance and fiduciary concepts apply to: (i) the operation of heath and other welfare benefit plans; (ii) determining whether service providers are fiduciaries; and (iii) conflicts of interest for plan sponsors, including those plan sponsors who operate in the healthcare industry.
Advanced Preparation: None