Who is this checklist for?
This checklist is for private employers that sponsor a health and welfare plan: medical, dental, vision, life, disability, health FSAs and HRAs. If you aren’t sure your plan is covered, start with who is subject to ERISA and ERISA vs. non-ERISA plans. Government and most church plans are outside ERISA. Retirement plans have their own list of notices and testing, which this page does not cover.
Each item below shows what it is, which plans it applies to, and when it is due. Dates assume a calendar-year plan. If your plan year starts on another date, shift the dates to match.
Which plan documents and disclosures are required?
Every ERISA plan needs a written plan and a plain-language summary of it. These are the documents participants and the DOL ask for first.
| Item | What it is | Who it applies to | When |
|---|---|---|---|
| Written plan document (wrap document) | The governing document. It names the fiduciary and plan administrator, and sets out funding, amendment and claims procedures. Carrier certificates usually leave these out, so insured plans often use a wrap. | All ERISA welfare plans, insured or self-funded | In place when the plan starts; amended whenever terms change |
| Summary plan description (SPD) | Plain-language description of benefits, eligibility, claims and ERISA rights | All ERISA welfare plans | Within 90 days of a person becoming covered; within 120 days for a new plan. Updated every 5 years if amended, every 10 years if not |
| Summary of material modifications (SMM) | Notice of a change to the plan or to information in the SPD | All ERISA welfare plans | Within 210 days after the end of the plan year in which the change is adopted. Within 60 days of adoption for a material reduction in group health benefits |
| Summary annual report (SAR) | Narrative summary of the Form 5500 | Plans that file Form 5500, except totally unfunded plans paid only from the employer’s general assets | Within 9 months after the plan year ends, or 2 months after the extended Form 5500 due date |
| Summary of benefits and coverage (SBC) | Standard template comparing coverage, with a link to the uniform glossary | Group health plans (not standalone dental or vision) | With enrollment materials; 30 days before the plan year on automatic renewal; within 7 business days of a request; 60 days before a mid-year change that affects the SBC |
| Plan documents on request | Copies of the plan, SPD, latest Form 5500 and contracts | All ERISA plans | Within 30 days of a written request |
Which government filings are due?
The main government filings for an employer health plan are the Form 5500, the gag clause attestation, the RxDC report and the Medicare Part D disclosure to CMS. These go to the DOL, IRS or CMS. Most are made by the employer or carrier, but the plan keeps the legal duty even when a vendor files.
| Item | What it is | Who it applies to | When |
|---|---|---|---|
| Form 5500 | Annual report on the plan’s finances and operations | Welfare plans with 100 or more participants at the start of the plan year, and funded plans of any size. Small unfunded or insured plans are generally exempt | Last day of the 7th month after the plan year ends (July 31). Form 5558 extends it 2½ months (October 15) |
| Gag clause attestation (GCPCA) | Statement to CMS that the plan’s contracts don’t block access to its cost, quality and claims data | Insured and self-funded group health plans; not excepted benefits or account-only plans | By December 31 every year |
| RxDC report | Prescription drug and health care spending data sent to CMS | Insured and self-funded group health plans. Carriers, TPAs and PBMs usually file, under a written agreement | By June 1 for the prior calendar year |
| Medicare Part D disclosure to CMS | Online form stating whether the plan’s drug coverage is creditable | Plans that offer prescription drug coverage to anyone eligible for Medicare | Within 60 days after the plan year begins; within 30 days after the drug plan ends or its creditable status changes |
Related tax filings, such as ACA reporting on Forms 1095-B and 1095-C, sit outside ERISA but belong on the same calendar.
Which notices are required?
Federal health laws added to ERISA require a set of notices. Many can go in the open enrollment packet each year.
| Item | What it is | Who it applies to | When |
|---|---|---|---|
| COBRA general notice | Explains the right to continue coverage after a qualifying event | Group health plans of employers with 20 or more employees in the prior year | When coverage begins (within 90 days) |
| COBRA qualifying event and election notices | Employer tells the plan administrator about a qualifying event; the administrator offers COBRA | Same as above | Employer: within 30 days of the event. Administrator: within 14 days of notice, or 44 days if the employer is also the administrator |
| HIPAA special enrollment notice | Explains the 30-day right to enroll after losing other coverage, marriage, birth or adoption | All group health plans | At or before the first chance to enroll |
| HIPAA notice of privacy practices | Explains how the plan uses and protects health information | Self-funded plans, and insured plans that receive more than summary or enrollment information | At enrollment; a reminder of availability at least every 3 years |
| Medicare Part D creditable coverage notice | Tells Medicare-eligible people whether the plan’s drug coverage is creditable | Plans with prescription drug coverage | Before October 15 each year, and when a Medicare-eligible person joins |
| CHIPRA notice | Tells employees about state Medicaid and CHIP premium assistance | Employers with a group health plan in a state that offers premium assistance; most send it to all employees | Annually |
| WHCRA notice | Describes coverage for mastectomy-related reconstruction, prostheses and complications | Group health plans that cover mastectomies | At enrollment and annually |
| Michelle’s Law notice | Describes continued coverage for a dependent student on a medically necessary leave | Plans that require proof of student status for dependent coverage (usually only past age 26) | With any notice asking for student status certification |
Fiduciary and operations.
These items aren’t sent to anyone on a fixed date. They are what the DOL looks for in an investigation, and what protects the people who run the plan.
| Item | What it is | Who it applies to | When |
|---|---|---|---|
| Claims and appeals procedures | Written rules for deciding claims and appeals within federal time limits | All ERISA welfare plans. Insured plans rely on the carrier but should confirm the procedures in writing | Ongoing. For health claims: urgent within 72 hours, pre-service 15 days, post-service 30 days; at least 180 days to appeal |
| Fiduciary process and committee record | A named fiduciary, a defined decision process, and minutes showing how vendors, fees and plan changes were reviewed | All ERISA plans. A committee isn’t required, but a documented process is how fiduciaries show prudence | At least annually and at each major decision |
| 408(b)(2) service provider disclosures | Written disclosure of services and all direct and indirect compensation from brokers and consultants, added for health plans by the CAA 2021 | Group health plans whose brokers or consultants expect $1,000 or more in compensation for contracts entered, extended or renewed on or after December 27, 2021 | Reasonably in advance of signing or renewing. Changes within 60 days. If a provider won’t disclose, request it in writing; after 90 days the fiduciary must notify the DOL |
| ERISA fidelity bond | Insurance that protects the plan against theft by people who handle plan assets | Only plans with plan assets, such as a trust or insurer refunds. Plans paid entirely from general assets are exempt | Covers at least 10% of funds handled, $1,000 minimum, $500,000 maximum per plan; set each plan year |
| Mental health parity NQTL comparative analysis | Written analysis showing that limits like prior authorization and network rules are no stricter for mental health and substance use benefits than for medical benefits | Group health plans that cover mental health or substance use benefits | Must exist now; produced on request from the DOL. The 2024 rule’s new parts are not being enforced, but the CAA 2021 statutory requirement still applies |
| Timely deposit of employee contributions | Employee premium contributions become plan assets and must be used or deposited promptly | Plans that collect employee contributions | As soon as they can reasonably be segregated, and no later than 90 days after withholding |
A calendar for a calendar-year plan.
| Month | What’s due |
|---|---|
| January to March | Medicare Part D disclosure to CMS within 60 days of the plan year start |
| June 1 | RxDC report for the prior calendar year |
| July 31 | Form 5500 for the prior plan year, or file Form 5558 |
| September 30 | SAR, if Form 5500 was not extended |
| Before October 15 | Medicare Part D creditable coverage notice |
| October 15 | Extended Form 5500 |
| Open enrollment | SBC, CHIPRA, WHCRA and special enrollment notices; 408(b)(2) disclosures before renewals are signed |
| December 15 | SAR, if Form 5500 was extended |
| December 31 | Gag clause attestation |
For the 2025 plan year, the extended SAR is due December 15, 2026, and the 2026 gag clause attestation is due December 31, 2026.
What does it cost to miss a deadline?
Missing an ERISA deadline can cost up to $2,739 a day for a late Form 5500, and other failures carry their own penalties. The DOL made no inflation adjustment to ERISA civil penalties for 2026 (91 FR 31358), so the 2025 amounts still apply.
| Failure | Penalty |
|---|---|
| Late or missing Form 5500 | Up to $2,739 a day |
| Failure to provide an SBC | Up to $1,443 per failure |
| Missing CHIPRA notice | Up to $145 a day per employee |
| Not providing plan documents within 30 days of a request | Up to $110 a day, which a court can award to the participant |
| Breach of fiduciary duty | Restoring plan losses, plus a civil penalty of 20% of the amount recovered |
Penalties aren’t the only exposure. Participants can sue for benefits and for breach of fiduciary duty, and fiduciaries can be personally liable for plan losses.
What are the most common gaps?
- No document beyond the carrier’s certificate. The insurance policy is not an ERISA plan document or SPD.
- An SPD that is years out of date. Plan changes made at renewal never make it into an SMM or a new SPD.
- Assuming the vendor filed. Carriers and TPAs often file the gag clause attestation and RxDC report, but the plan is responsible if they don’t. Get written confirmation.
- No broker or consultant disclosure on file. Renewals signed without a 408(b)(2) disclosure leave the fiduciary exposed.
- No parity analysis. Many plans have never asked their TPA or carrier for the NQTL comparative analysis.
- No record of decisions. A prudent process that isn’t written down is hard to prove.
Ethos Benefits runs this calendar for clients as part of its ERISA compliance work; the compliance services page lists the rest.