Frequently Asked Questions

All ERISA-covered benefit plans, including group health plans and other welfare plans, must, by law, be administered in accordance with a written plan document. ERISA, HIPAA, and other federal laws require the plan document to contain certain specified provisions. Many employers assume that insurance contracts for fully insured products are written plan documents. Insurance companies, however, draft their contracts to comply with state insurance laws and, as a result, the contracts do not contain many of the required or recommended provisions that protect the plan, the employer, and plan fiduciaries.

A Wrap Plan Document is designed to meet plan documentation requirements under ERISA and other federal laws and to incorporate all other welfare plans, insurance contracts, and other relevant documents into a single plan. These materials can be kept together for administrative ease. The Wrap Plan Document provides additional legal protection for the employer and plan fiduciaries and can simplify plan administration.

ERISA (the federal Employee Retirement Income Security Act) requires employers who are plan administrators of their group health plans to maintain and distribute summary plan descriptions (SPDs) to plan participants. The SPD describes important information about the plan in language that can be understood by the typical participant. The SPD must accurately reflect the contents of the plan and must include specific information required under federal law, much of which is typically missing from the benefits summaries and insurance certificates distributed by insurance companies.

The Wrap SPD is designed to "wrap around" the existing certificates of insurance and benefit plan booklets for each fully-insured or self-funded benefit to provide the information necessary to comply with ERISA's reporting and disclosure requirements. To be compliant with ERISA, the Wrap SPD and accompanying benefit plan component documents must be distributed to plan participants.

The agent for service of legal process would be the entity authorized to receive legal documents, such as a subpoena, on behalf of the employer. In almost every case this will be the employer itself, but it could also be a corporate title or officer.

The Plan Administrator is the entity specifically designated by the Wrap Plan Document or under ERISA that is responsible for the ERISA obligations for the entire Wrap Plan, including all component plans or programs. Please note that the Plan Administrator can delegate some of its responsibilities, such as the administration of a particular component benefit program, to a third party (such as a TPA or insurance company).

For fully-insured benefits, users are prompted to enter the contact information for the carrier for each particular benefit program. Wrap360 generally recommends using the contact information that members can use to find out more information regarding claims administration for each benefit component plan.

For self-insured benefits, users are prompted to enter the contact information for either the employer/plan sponsor or a third party administrator. If the Plan Administrator designates the administration of a particular component benefit program to a TPA, you would enter the TPA's information for that particular component benefit program.

The Plan Administrator can delegate some of its responsibilities, such as the administration of a particular component benefit program, to a third party (such as a TPA or insurance company). The term "third party administrator" or "TPA" typically means a person or entity that performs the day-to-day operations of the program, which may include collecting charges or premiums, or adjusting or settling claims in connection with health insurance coverage pursuant to a service contract. If this is the case for a particular benefit, you would enter the TPA's information for that particular component benefit program. Please note, however, that it is the Plan Administrator that remains liable under ERISA for the proper administration of these services, as well as for the selection of the TPA.