The foundation: plan documents, HIPAA and FMLA together.
ERISA, HIPAA and FMLA are the three obligations nearly every employer with a health plan runs into, whatever the size or funding. Arranged together, they give you one place to check that the written plan, the privacy duties and the leave rules are all in order.
Three duties, one checkup.
Each has its own guide with the rules behind it.
ERISA Plan Documents
A written plan document and summary plan description are the base of the plan.
HIPAA Privacy and Security
Safeguards for health information and rules for the vendors that handle it.
FMLA Leave Rules
Job-protected leave and the duty to keep group health coverage going during it.
Where the gaps usually are.
Plans Without a Plan Document
A benefits guide or carrier certificate is not a plan document. See what the plan has to show.
Employers Near the FMLA Threshold
FMLA applies to employers with 50 or more employees. See how leave connects to coverage.
Services Without Protection
Ask what protection comes with the service. See what to ask.
A short annual checkup that catches the usual gaps.
Most employers do not fail these three areas by ignoring them. They fail by assuming someone else handled them. The plan document was supposed to come with the policy. The HIPAA vendor agreements were supposed to be in the contract. The leave policy was written years ago and has not been checked against the current headcount. A single annual checkup puts each assumption in front of a person who can confirm it.
The checkup is mostly about documents and names. For each area, ask what governs it, where it is kept, who owns it and when it was last reviewed. Where the answer is unclear, that is the gap. Because requirements depend on size, funding and plan type, confirm the specifics with your advisor or counsel.
The questions employers ask.
Five questions to settle first.
Do small employers need all three?
ERISA applies to most employer health plans. HIPAA duties are heavier for self-funded plans. FMLA applies to employers with 50 or more employees. We check what applies to you.
Is a benefits guide a plan document?
No. A benefits guide and a carrier certificate are not the same as the written plan document and summary plan description that ERISA calls for.
What does HIPAA require of an employer plan?
Privacy and security safeguards for protected health information and rules for the vendors that handle it. How much applies depends on whether the plan is insured or self-funded.
What does FMLA require for health coverage?
The employer must keep group health coverage going during protected leave on the same terms as if the employee were working.
Can these be bundled with COBRA and ACA reporting?
Yes. The continuation and reporting bundle covers those, and you can arrange both together.
How often should we do the checkup?
Once a year is a sensible default, and again when something changes, such as a headcount jump, a new vendor or a new plan. Tie it to the renewal calendar so it does not get skipped.
Who should own the checkup?
Usually HR or a named compliance owner, with support from your advisor and counsel. What matters is that one person is accountable for finishing it.
Ready? Upload your renewal, or talk it through with someone first. No cost, no obligation.
General information about compliance services, not legal or tax advice. Plan-specific questions belong with your counsel, and we will bring them in.
Related guides.
Continuation and Reporting Bundle
COBRA, ACA, PCORI and Medicare reporting together.
ICHRA Compliance Bundle
What an ICHRA brings with it on the compliance side.
Compliance Service Bundles for Employers
All the bundles in one place.
Where the Rules Come From.
The laws and rules named on this page link to the statute or regulation they come from. This is general information, not legal or tax advice, and rules change, so check the current text.
ERISA (29 U.S.C. Chapter 18)
The federal law that sets reporting, disclosure and fiduciary rules for employer-sponsored benefit plans.
Family and Medical Leave Act (29 U.S.C. Chapter 28)
Job-protected leave and group health coverage during it.
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. →