Compliance. Every obligation, owned and proven.

Your health and welfare plans carry federal obligations under ERISA, the ACA, COBRA, HIPAA, mental health parity law and the Consolidated Appropriations Act, and the responsibility stays with your company as plan sponsor. Ethos Benefits builds a compliance calendar for your plans, prepares or coordinates each item with its owner, and keeps proof it was done.

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What you get.

Most benefits compliance items come up once a year, so nobody owns them until a deadline is close. When a vendor misses one, the responsibility still stays with the plan.

  1. A compliance audit at the startYour plans, documents, notices and filings reviewed when Ethos begins, with every gap listed and fixed.
  2. A compliance calendarEvery requirement that applies to your plans, with an owner, a due date and a status, kept current in your Fiduciary OS.
  3. Plan documents and disclosuresPlan and wrap documents, SPDs, SMMs, SBCs and Section 125 documents reviewed and kept current.
  4. Filings and feesForm 5500, the PCORI fee and the gag clause attestation prepared or supported, and RxDC reporting coordinated with your vendors.
  5. Required noticesEvery participant notice created, distributed and documented.
  6. Access to ERISA attorneysQuestions of plan interpretation answered by ERISA counsel, with the guidance kept in your record.

The full compliance list.

These are the federal obligations Ethos covers for employer health and welfare plans. Your calendar includes only the ones that apply to your plans.

ERISA

  • A written plan document, and a wrap document that brings carrier documents under one ERISA plan
  • The Summary Plan Description, Summary of Material Modifications and Summary Annual Report
  • Claims and appeals procedures
  • Form 5500, and the Form 5558 extension when needed
  • Service provider compensation disclosures under ERISA § 408(b)(2), collected and reviewed every year
  • ERISA fidelity bond, where required
  • Fiduciary conduct and the committee record. See ERISA compliance

Affordable Care Act

  • Employer mandate and affordability testing
  • Summaries of Benefits and Coverage
  • The PCORI fee, on Form 720, for self-funded plans
  • Forms 1094-C and 1095-C, as an added service. See ACA compliance

COBRA

  • General and election notices, coordinated with your COBRA administrator
  • COBRA premiums for self-funded plans, from your premium equivalent rates

HIPAA

  • Privacy and special enrollment notices
  • Business associate agreements with every vendor that handles protected health information

Consolidated Appropriations Act, 2021

  • The annual gag clause attestation
  • Prescription drug data collection (RxDC) reporting, coordinated with your vendors
  • Broker and consultant compensation disclosure
  • Access to your plan’s cost, quality and claims data

Consolidated Appropriations Act, 2026

  • New disclosure, rebate and audit requirements for pharmacy benefit managers, tracked so PBM contracts signed now anticipate them. See pharmacy and PBM

Mental health parity

Other required notices

  • Medicare Part D creditable coverage, to employees and to CMS
  • CHIPRA (Medicaid and CHIP premium assistance)
  • Women’s Health and Cancer Rights Act
  • Michelle’s Law
  • USERRA
  • FMLA

Tax rules

Ongoing

  • A compliance calendar with an owner for every item
  • HR hotline access, handbooks and document review
  • Support with Department of Labor and IRS inquiries and audits, as an added service

What’s on the calendar.

ItemWhat it isWhen it is due
Form 5500The plan’s annual report to the Department of LaborThe last day of the seventh month after the plan year ends, with an extension available
Summary Annual ReportA summary of the Form 5500 for participantsNine months after the plan year ends, or two months after an extended 5500 deadline
PCORI feeA per-person fee on self-funded plans, reported on Form 720July 31 of the year after the plan year ends
RxDC reportPrescription drug and health care spending data reported to CMSJune 1 each year
Gag clause attestationConfirmation that your contracts don’t block access to your plan’s dataDecember 31 each year
Medicare Part D noticesWhether your drug coverage is creditable, to employees and to CMSEmployees before October 15; CMS within 60 days after the plan year starts
Compensation disclosuresWhat brokers and consultants are paid, disclosed to the planBefore a contract is signed or renewed

Where the proof lives.

Each item on your calendar is kept in the Ethos Fiduciary OS with its owner, its due date and proof it was done. When your committee reviews compliance under the Fiduciary Framework™, the record is already there.

Part of your Fiduciary Framework™.

Every Ethos service reports to your benefits committee. The work is reviewed at your quarterly committee meeting, each decision is recorded with the reasoning behind it, and the record lives in your Ethos Fiduciary OS. That is what lets your committee show the plan was run prudently.

See the Fiduciary Framework™ · How fiduciary governance works

Related reading.

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Sources

  1. Reporting and Disclosure Guide for Employee Benefit Plans, U.S. Department of Labor, Employee Benefits Security Administration
  2. Patient Centered Outcomes Research Trust Fund fee, questions and answers, Internal Revenue Service
  3. Prescription Drug Data Collection (RxDC), Centers for Medicare & Medicaid Services
  4. Gag Clause Prohibition Compliance Attestation, Centers for Medicare & Medicaid Services
  5. Creditable coverage for employers and plan sponsors, Centers for Medicare & Medicaid Services

Questions employers ask about this.

Does a fully insured plan have compliance obligations?

Yes. The carrier handles some items, but the employer still owns others, such as employee notices and, for plans with 100 or more participants, the Form 5500. Fully insured welfare plans with fewer than 100 participants are generally exempt from filing a Form 5500.

Who pays the PCORI fee?

For a fully insured plan, the insurer pays it. For a self-funded plan, the employer as plan sponsor reports and pays it on Form 720, due July 31 of the year after the plan year ends.

Can our TPA or carrier handle compliance for us?

They handle pieces of it, and should. But many duties stay with the plan sponsor even when a vendor files on your behalf, so each item needs a named owner and proof it was done.

Does Ethos give legal advice?

Ethos is not a law firm. Ethos clients have access to ERISA attorneys for plan interpretation, and Ethos works with your own counsel when a question needs a legal opinion.

What happens if the DOL or IRS contacts us?

Ethos supports special compliance projects, including Department of Labor and IRS inquiries, audits and investigations, as an added service.

See what your plan is really costing you.

A Strategic Analysis starts with your plan documents and your broker agreement, then shows you what your plan costs, where the risk sits, and what a committee would decide with the full picture.

Request a Strategic AnalysisCall (407) 803-4710