ERISA for employer health plans, in one place.
ERISA is the federal law that sets standards for most private employer health plans: written plan documents, disclosures to participants, claims procedures, annual reporting and fiduciary responsibility. Start with the area that matches your question.
Four areas, and the page for each.
Plan Documents And Disclosures
The documents and disclosures a plan needs.
Annual Reporting
The Form 5500 and the penalties for filing late.
Fiduciary Duties
Choosing and monitoring the people and vendors who run the plan.
Claims And Appeals
How denied claims and appeals have to be handled.
Prudence is shown by process.
ERISA Compliance Checklist
The complete guide for Michigan employers.
Fiduciary Process Review
A review of how your plan decisions are made and recorded.
Fiduciary And Governance Services
Support for the people responsible for the plan.
Contract And Rebate Audits
Checking the contract against what you are charged.
Pharmacy Benefit Consulting
Reading pharmacy pricing and contracts.
Employer-Funded PBMs
ScriptGuideRX and more.
Employer-Funded PBMs Compared
An inside look at the options.
What has to be written down and sent.
SPD Vs. Benefits Guide
Why a benefits guide is not a summary plan description.
Form 5500 And Plan Documents
How the filing ties to your plan documents.
What We Have Not Seen, We Can Read
Reading the plan documents you have.
Summary Of Benefits And Coverage
What the SBC is and when it is due.
Required Employee Notices
The notices employees must receive.
Gag Clause Attestation
What the annual attestation is.
Checking what the plan paid.
Denied Claims And Appeals
The appeal process and what employers should know.
Claims Advocacy
Help for employees with a claim problem.
Claims Audit And Recovery
Finding and recovering overpayments.
How A Claims Audit Runs
What an audit involves from start to finish.
Claims And Stop-Loss Reporting
Reporting for self-funded plans.
DOL And IRS Audits
What an audit looks like and how to prepare.
Why process and documentation matter now.
Fiduciary Duty Claims
Plan participants have brought class actions against employers alleging that they failed to monitor plan costs, including administrative fees and pharmacy pricing. A documented review process is the usual defense. Keeping minutes of plan reviews, benchmarking and vendor decisions helps show a prudent process. Ask your ERISA counsel what level of documentation fits your plan.
Pricing And Data Disputes
Self-funded employers have sued administrators and pharmacy benefit managers over fees, drug pricing and access to their own claims data. Contract language on audit rights, fee disclosure and data access is worth reviewing before you sign or renew, and counsel can advise on what to negotiate.
Transparency Rules
Federal law now bars gag clauses in carrier and administrator contracts and requires an annual attestation. See the gag clause page above. Review your carrier and administrator contracts for restrictive terms, and ask who is responsible for the annual attestation. Counsel can confirm what applies to your plan.
State Action
On October 8, 2026 the Michigan Attorney General filed a federal antitrust suit against Blue Cross Blue Shield of Michigan, alleging anti-competitive practices. These are allegations, and nothing about your plan changes today.
Supplemental Benefits
A newer wave of suits challenges how supplemental benefit arrangements are sold and paid for, including commissions and conflicts of interest. Ask how any supplemental product is priced, who is paid, and whether the arrangement was reviewed. Counsel can help you judge your exposure.
Common Questions About ERISA
What is ERISA?
The Employee Retirement Income Security Act, the federal law that sets standards for most private-sector employer benefit plans, including group health plans.
Does ERISA apply to our plan?
Most private employer plans are covered. Governmental and church plans are generally not. If you are not sure, send us your plan documents and we will help you sort it out.
Is an insured plan exempt from ERISA?
No. Buying coverage from a carrier is a way of funding the plan. The plan itself is still subject to ERISA.
Who is a fiduciary?
Anyone who exercises discretionary authority or control over the plan or its assets. That often includes the employer and the individuals who choose and monitor the plan vendors.
How do we show we acted prudently?
Document your decisions: who reviewed what, which options were compared, and how vendors and fees are monitored. The fiduciary process review page explains what that looks like.
Is this legal advice?
No. For a question specific to your company, involve your counsel. We can help you frame the question and bring the plan facts.
The rules in one place.
Church Plans and Religious Employers
Which federal benefit rules apply to church plans and which do not.
Grandfathered Health Plans
Which ACA rules a grandfathered plan is exempt from and which changes end the status.
Employee Contributions and Plan Assets
Why withheld premiums must reach the plan promptly, and the controls that keep them in step.
IRS Rules For Employer Health Plans
The ACA forms, IRS letters and tax rules for employer plans, in one place.
DOL Rules For Employer Health Plans
Form 5500, COBRA, plan documents and notices, in one place.
HIPAA And Privacy For Employer Health Plans
Plan sponsor basics, vendor risk and breach readiness, in one place.
Transparency And Pharmacy Rules
Gag clauses, PBM contracts and disclosures, in one place.
Medical Loss Ratio Rebates
What an employer should do with one.
Mental Health Parity
The comparative analysis your plan has to show.
Section 1557 Nondiscrimination
How the rule reaches group health plans.
ACA Patient Protections
Choice of provider, OB-GYN access and emergency care.
Claims, Appeals And External Review
What a plan must offer when a claim is denied.
Broker And Consultant Compensation Disclosure
ERISA 408(b)(2)(B) basics.
Medical Child Support Orders And QMCSOs
What a qualified order requires.
MEWA And Form M-1 Basics
What a multiple employer arrangement is.
ERISA Preemption: Insured Versus Self-Funded
Why state mandates reach plans differently.
ERISA Fidelity Bond Rules
Who handling plan funds must be bonded.
Voluntary Fiduciary Correction Program
How plan officials can correct fiduciary breaches.
Participant Requests For Plan Documents
The 30-day rule when an employee asks.
COBRA Disability Extension
11 more months for disabled beneficiaries.
COBRA Second Qualifying Event
Extending to 36 months for family members.
ERISA Voluntary Benefit Safe Harbor
The four conditions that keep voluntary coverage outside ERISA.
Health FSA COBRA Rules
When a health FSA must offer COBRA and how the remaining-benefit test works.
AI in Employee Benefits Administration
Fiduciary, HIPAA and Section 1557 questions for vendors.
ERISA Section 510 Retaliation Guide
Protecting benefit rights in HR decisions.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents — two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
An independent employee benefits consulting firm. We look at the entire benefits program: cost, plan performance, risk and administration.
Switch to CFH. Unhappy with your broker? Your employees won’t notice. You will. →
Cookies on This Site
We use cookies to keep the site working properly and to understand how it is used. You can decline anything that is not essential. See our Privacy Policy for the detail.
- Essential: needed for the site to load and for you to move around it. These cannot be switched off.
- Analytics: tell us which pages get read, so we know what is worth writing more of.
- Advertising: set by third parties such as ad and social platforms to measure and target campaigns.