Fiduciary Responsibilities

What is an ERISA fiduciary?

Any person who:

ERISA has a “functional” definition – not dependent on job title or documents.

Fiduciary Tip #1

Fiduciary Tip #1 – Carefully select and monitor service providers for the plan.

Tips for selecting service providers:

Fees and expenses:

Monitor plan service providers:
Plan fiduciaries must periodically monitor service providers to make sure the services are being delivered as agreed.

Remember – Fiduciary can be held liable if the service provider fails to perform services.

Fiduciary Tip #2

Fiduciary Tip #2 – Make required disclosures to plan participants (and beneficiaries).

What is an SPD?

Who gets and SPD and when?

What if the plan changes?

Qualified Medical Child Support Orders (QMCSOs)

More automatic disclosures:

Disclosures on request:

How to furnish documents?

Failure to provide documents:

Fiduciary Tip #3

Fiduciary Tip #3 – Follow terms of plan and understand your responsibilities.

“Follow the terms of the plan” means:

Claims procedures for group health plans:

DOL Regulation 29 CFR 2560.503-1

What is a claim for benefits?

Time limits for deciding group health claims:

* 15-day extension available
Special rules for “concurrent care”

Initial denial notice contents:

Appeals procedures for group health plans:

Review denial notice contents: