Ask the Experts June 11, 2024

What Records Should ERISA Plans Retain?

Experts from Groom Law Group and CAPTRUST answer questions concerning retirement plan administration and regulations.

Reported by

Q: As a plan administrator, I know the Employee Retirement Income Security Act requires that I retain plan records. But what is a plan record exactly? Are fee benchmarking reports plan records? How about documentation from Requests for Proposal? Legacy service provider records?

Kimberly Boberg, Kelly Geloneck, Emily Gerard and David Levine, with Groom Law Group, and Michael A. Webb, senior financial adviser at CAPTRUST, answer:

Never miss a story — sign up for PLANSPONSOR newsletters to keep up on the latest retirement plan benefits news.

A: Good question! Though Sections 107 and 209 of ERISA are not specific with regard to items, such as fees and service provider records, it is typically best to be as inclusive as possible when determining whether an item is or is not a plan record, since (a) The Department of Labor has a degree of latitude as to what it can request in a plan audit and (b) even if the DOL does not request a particular document, it could be a record that can be requested in litigation. Thus, all the items that you indicated should presumably be retained. When in doubt as to whether an item is a plan record, plan sponsors should consult with their outside ERISA counsel.

NOTE: This feature is to provide general information only, does not constitute legal advice and cannot be used or substituted for legal or tax advice.

Do YOU have a question for the Experts? If so, we would love to hear from you! Simply forward your question to Amy.Resnick@issgovernance.com with Subject: Ask the Experts, and the Experts will do their best to answer your question in a future column.

Compliance June 10, 2024

Health and Employer Groups Push for Improved Health Pricing Transparency

Two pending bills would require greater disclosures to health payers.

Reported by

The ERISA Industry Committee and other benefits and health industry groups have endorsed two bills that aim to improve transparency and lower costs in the administration of health care plans.

The two bills are the Lower Costs, More Transparency Act, which passed the House of Representatives in December; and the Pharmacy Benefit Manager Reform Act, which passed the Senate Health, Education, Labor and Pensions Act in May 2023.

Never miss a story — sign up for PLANSPONSOR newsletters to keep up on the latest retirement plan benefits news.

The Lower Costs, More Transparency Act, introduced by Representative Cathy Rodgers, R-Washington, aims to improve hospital pricing information. The bill would authorize regulations to require hospitals to publish their prices, including discounted and negotiated charges. Clinical labs, imaging services and ambulatory surgical centers that participate in Medicare would also be subject to these requirements.

Additionally, pharmacy benefit managers would have to report to health plans information on rebates and fees for covered drugs and permit plan fiduciaries to “audit certain claims and cost information without undue restrictions.”

Lastly, the legislation would prohibit spread–pricing, a practice in which the PBM charges the payer more than they pay the pharmacy, for pharmacies dealing with Medicaid.

The Pharmacy Benefit Manager Reform Act, introduced by Senator Bernie Sanders, I-Vermont, would require pharmacy benefit managers to report to health plans a variety of pricing information, including: “the amount of prescription drug copayment assistance funded by drug manufacturers, a list of covered drugs billed under the plan during the reporting period, and the total net spending by the health plan on prescription drugs.”

Every six months, PBMs would also be required to report information on drugs that were purchased by the plan at pharmacies that are wholly or partially owned by the pharmacy benefit manager.

The Purchaser Business Group on Health, the American Benefits Council, the National Alliance of Healthcare Purchaser Coalitions, the Silicon Valley Employers Forum, the HR Policy Association, the Business Group on Health, and the Small Business Majority also endorsed the two bills.

 

 

 

 

«