ERISA applies to health and welfare plans as well as to retirement plans. However, for years after its enactment, the predominant focus of ERISA-related regulatory activity, plan sponsor compliance and litigation was on retirement plans. Following the enactment of the Affordable Care Act, there has been increased awareness of ERISA’s: (i) health plan-related compliance requirements, as well as (ii) fiduciary provisions, and liability for failure to comply. Accordingly, health plan sponsors, and those making decisions (including an “inadvertent fiduciary”) involving health plan operations need to be aware of these considerations; as do plan service providers, including insurers and PBMs. Another compliance area involves utilization of sponsor services, or products, by employees covered by the sponsor’s health plan.
This program will focus primarily on: (i) the range of ERISA considerations applicable to health plans, from documentary compliance through health plan operational issues; (ii) 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 (iii) conflict of interest/ prohibited transaction considerations when plan sponsors provide services/products to their health plan covered employees.
What You Will Learn
- ERISA compliance basics for the health plan sponsor
- Retiree medical plans and health plan related M&A considerations
- MEWA considerations; association health plans
- Fiduciary status and duties
- Prohibited transactions, DOL exemptions and ERISA enforcement
- Litigation update
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