Put participants first
For plans subject to ERISA, fiduciaries must act in participants’ and beneficiaries’ interests, provide benefits and pay only reasonable plan expenses. They must act prudently and follow lawful plan documents.
A fiduciary role is determined by the functions performed, not just a job title. Personal liability and corrective obligations may arise from breaches. Not every employer plan is subject to ERISA; governmental plans generally have different rules.
Maintain a documented review process
Keep plan documents and required participant disclosures current. Select and monitor service providers, evaluate fees and performance, document decisions and maintain appropriate internal controls.
Retirement plans also require attention to investments, diversification and participant contributions. Health-plan oversight focuses on the relevant coverage, administration, claims and provider arrangements. The applicable duties depend on the plan.
Compensation and transparency
CAA-related rules include service-provider compensation disclosures and restrictions on gag clauses in health-plan agreements. Fiduciaries should collect and review required direct and indirect compensation information and understand their access to cost and quality data.
Transparency in Coverage requirements and related reporting duties also need review. Confirm what your carrier, administrator and other vendors handle, what the employer retains responsibility for and how compliance is documented.
Surprise billing and mental health parity
Review applicable No Surprises Act protections and participant communications. Evaluate mental health and substance use disorder benefits under current parity requirements, including required comparative analyses where applicable.
These duties can involve several federal rules, not just one law. Do not assume delegating administration removes all employer responsibility. Use qualified advisers to assess the requirements for your specific plan.
A practical employer checklist
Identify responsible people, confirm plan documents and disclosures, collect compensation information, review provider fees and contract restrictions, verify required reporting and document follow-up.
Monitor changes in law and the services your vendors provide. Penalties and legal exposure vary by requirement and circumstances; this guide does not provide a universal penalty amount or individualized legal advice.
Sources and further reading
Department of Labor: health-plan fiduciary responsibilitiesGeneral education, not individual legal or tax advice. Eligibility, plan design and current requirements should be reviewed for your organization.