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Plan Document Changes to Accommodate the Employer Mandate Requirements

We have received several questions about whether plan sponsors need to include the employer mandate language in their plan document.  


To whom does this apply?

This language requirement applies for any applicable large employers in 2015 that need to comply with the employer mandate (those who employ 100 or more full-time employees and full-time employee equivalents). This language requirement will expand in 2016 to employers who have 50 to 99 full-time employees and full-time employee equivalents. 


What changes must impacted plan sponsors make to the plan documents?

Plan sponsors will need to place specific information concerning the measurement/look back, administrative and stability periods, into their plan document. This is required for ongoing employees, as well as variable hour, seasonal and part-time employees. 


What steps should plan sponsors take to make the necessary changes?  

Plan sponsors who will need an amendment to include the required information should discuss this with their Client Relationship Manager. 


Why do plan sponsors need to comply? 

Employers must comply with this requirement, as the Summary Plan Description (SPD) rules require that a plan include all requirements regarding eligibility for participation and plan benefits. The SPD should describe the plan's provisions relating to eligibility to participate in the plan, as well as a statement of the conditions pertaining to eligibility to receive benefits and a description or summary of the benefits. 


When do plan sponsors need to comply?

Applicable large employers will need to comply on their first plan year on or after January 1, 2015. This requirement will expand to medium-sized employers with their first plan year in 2016.


Compliance Quarterly is being provided as an informational tool. It is recommended that plans consult with their own experts or counsel to review all applicable federal and state legal requirements that may apply to their group health plan. By providing this publication and any attachments, Meritain Health is not exercising discretionary authority over the plan and is not assuming a plan fiduciary role, nor is Meritain Health providing legal advice.