Compliance
Staying compliant with employee benefits regulations isn’t just smart business—it’s essential. We help ensure your benefits programs meet federal and state requirements.
Why Compliance Matters
Compliance in employee benefits isn’t optional—it’s a cornerstone of protecting your business and your people. Failing to meet federal and state regulations can result in costly penalties, audits, and reputational damage.
More importantly, maintaining compliance helps ensure your employees receive the benefits they’ve been promised, building trust and reducing risk. We stay ahead of changing laws and regulatory requirements so you can focus on supporting your workforce with confidence.
ERISA
The
Employee Retirement Income Security Act
(ERISA)
sets minimum standards for most voluntarily established health and retirement plans in the private sector. It governs how plans are administered, protects participants' rights, and requires clear communication about benefits. Employers must comply with ERISA’s rules around disclosures, fiduciary responsibilities, and claims procedures—or risk audits and penalties. Staying compliant ensures your plan operates transparently and lawfully.
COBRA vs. State Continuation
When employees lose group health coverage, both
COBRA
and
state continuation laws may offer temporary extension options—but which one applies depends on your group size and location. COBRA is a federal law that generally applies to employers with 20 or more employees, while state continuation laws (often called “mini-COBRA”) may apply to smaller groups. Understanding the differences and obligations under each law is crucial to ensuring former employees receive timely and accurate continuation notices.
Gag Clauses
Recent federal rules now prohibit group health plans and issuers from entering into agreements that restrict access to cost and quality information—known as "gag clauses." Plans must annually attest that they are in compliance with this requirement. Employers need to review contracts with TPAs and carriers to ensure no prohibited clauses exist and that required attestations are submitted on time. Transparency is the goal—and compliance is the law.
PCORI Fees
The
Patient-Centered Outcomes Research Institute (PCORI) fee is a small annual charge imposed on certain health plans to fund research that helps patients and providers make informed healthcare decisions. If you're a self-funded employer or sponsor an HRA, you're likely responsible for calculating, reporting, and paying this fee to the IRS. Deadlines typically fall in July, and missing them can result in penalties. Accurate reporting ensures compliance and supports valuable healthcare research.
