SPD, Plan Document, Certificate of Insurance – Do You Have What You Need?


A summary plan description (SPD) is the primary vehicle for informing participants and beneficiaries about their plan and how it operates. It must:

  • Be written for the average participant and be sufficiently comprehensive to apprise covered persons of their benefits, rights, and obligations under the plan; and
  • Accurately reflect the plan’s contents as of the date not earlier than 120 days prior to the date the SPD is disclosed.

SPDs are to be distributed automatically to participants within 90 days of becoming covered by the plan and to pension plan beneficiaries within 90 days after first receiving benefits. However, a plan has 120 days after becoming subject to the Employee Retirement Income Security Act (ERISA) to distribute the SPD. An updated SPD must be furnished every five years if changes are made to SPD information or the plan is amended — otherwise the SPD must be furnished every 10 years.

Plan documents are all documents related to plan, including the SPD. The plan administrator must furnish copies of certain documents upon written request and must have copies available for examination. These documents include the latest updated SPD, latest Form 5500, trust agreement, and other instruments under which the plan is established or operated. Copies must be furnished no later than 30 days after a written request. The plan administrator must make copies available at its principal office and certain other locations.

Evidence of coverage (EOC) is further information regarding the plan that details coverage for the plan period. Each insurance carrier will have an EOC booklet, also called a schedule of benefits. These documents are often called certificates of insurance. This EOC/schedule of benefits does not meet the SPD requirements under ERISA. The EOC explains the health benefits participants and their dependents have under the plan. It details the services that will and will not be covered and the actions employees must to take to receive the health benefits — such as paying a co-pay, meeting a deductible, or using particular health care providers. The EOC can also refer to a certificate or contract provided to a health plan member that contains information about coverage and other rights.

ERISA requires the plan sponsor (employer) to provide an SPD to all plan participants. The SPD may incorporate the carrier’s EOC by reference, which generally provides sufficient description of the plan’s benefits. However, the SPD also must include specific content, such as ERISA plan number, Employer Identification Number (EIN), plan financing method, and other information that would not be found in a carrier EOC. Many employers choose to do an SPD wrap, which incorporates all benefits in one document instead of having a separate one for each line of coverage.

According to the Department of Labor’s Final Rules Relating to Use of Electronic Communication and Recordkeeping Technologies by Employee Pension and Welfare Benefit Plans; Final Rule, you can distribute insurance certificates and various ERISA required plan documents electronically via a company website. The department allows electronic notification and distribution of documents by email, attachment to an email, or by posting documents on a company website. However, just placing the documents on a company website does not, by itself, satisfy ERISA’s disclosure requirements.

Under ERISA, the rules allow for electronic delivery of all documents that must be furnished or made available to participant and beneficiaries. This includes SPDs, summary annual reports, individual benefit statements, and investment-related information for participant-directed accounts. These rules are limited to disclosures that plans are required to make to participants and beneficiaries under ERISA.

Prior to implementing, a plan administrator must notify all participants and beneficiaries of the availability of the particular disclosure document by sending written or electronic notice that directs them to the document on the website.

Find and share New Orleans area health care prices with PriceCheck tool

Originally published by NOLA.com | The Times-Picayune
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on April 05, 2017 at 5:40 AM, updated April 06, 2017 at 12:06 PM
Going to a doctor or a hospital in metro New Orleans is like shopping blind: most consumers never know the price in advance. By collecting information from you and others, we can help change that.


NOLA.com | The Times-Picayune and WVUE Fox 8 News have partnered with ClearHealthCosts, a New York journalism startup, to set up the PriceCheck tool, listing hundreds of prices from health care providers in our region. Check it out, and use your insurer’s Explanation of Benefits, or EOB, form to add your prices. (Information on how to read your EOB form can be found here.)

This is part of our project “Cracking the Code: The real cost of health insurance.” Read our coverage here.

Hey Kids, Get to Work!

kids-workIf you have come to the conclusion that it is time for your children to start contributing to the revenue (rather than expense) side of your family’s income statement, there are a few things you need to know. Below is a good summary of things to consider before hiring your children to work for you:

Louisiana Employment of Minors

Child Labor

Louisiana’s child labor law is located at La. Rev. Stat. Ann. §§ 23:151 – 23:258. The law generally applies to any employer who employs minors. The law does not apply to minors employed in agriculture or domestic services in private homes.

Prohibited Employment

Minors Under 14

As a general rule, minors under 14 may not be employed at any time in Louisiana. However, minors under 14 may be employed if all of the following conditions are met:

  • The minor is at least 12 years old.
  • The minor’s parent or legal guardian is an owner or partner in the business in which the minor is to be employed.
  • The minor will work only under the direct supervision of the parent or legal guardian who owns or is a partner in the business.
  • All of the protections afforded to minors age 14 and 15 are afforded to minors age 12 and 13.
  • The minor obtains an employment certificate.

Minors Under 16

Minors under 16 may not be employed in the following occupations:

  • In connection with a poolroom or billiard room.
  • In connection with power-driven machinery.
  • In a manufacturing, processing, or mechanical establishment or occupation.
  • Close to any lounge or other location where alcoholic beverages are sold, except as otherwise provided by law.
  • In the distribution or delivery of goods or messages for any person engaged in the business of transmitting or delivering goods or messages.
  • Driving any motor vehicle on a public road.

Minors Under 18

Minors under 18 may not be employed in the following occupations:

  • In oiling, cleaning, or wiping machinery or shafting or applying belts to pulleys.
  • In or about any mine or quarry.
  • In or about places where stone cutting or polishing is done.
  • In or about plants that use, transport, or manufacture explosives or articles containing explosive components.
  • In or about iron or steel manufacturing plants, ore reduction works, smelters, foundries, forging shops, hot rolling mills, or in any other place in which the heat treatment of metals is done.
  • In the operation of machinery used in the cold rolling of heavy metals or in the operation of power-driven machinery for punching, shearing, stamping, bending, or planing metals.
  • In or about sawmills or cooperage stock mills.
  • In the operation of power-driven woodworking machines or off-bearing from circular saws.
  • In logging operations.
  • In the operation of a school bus transporting children to or from school.
  • In the operation of passenger or freight elevators or hoisting machines.
  • In spray painting or in occupations involving exposure to lead or its compounds or to dangerous or poisonous dyes and chemicals.
  • In any place in which the sale of alcoholic beverages constitutes its main business, unless the minor has a written contract to perform and is under the supervision of a parent or legal guardian. An establishment with a retail dealer’s alcoholic beverage permit or license where the sale of alcohol is not the main business may employ a person under 18 if the employment does not involve the sale, mixing, dispensing, or serving of alcoholic beverages for consumption on the premises.
  • In any establishment or occupation that the Executive Director of the Louisiana Workforce Commission determines hazardous or injurious to the life, health, safety, or welfare of the minor.

Theatrical Employment

A minor under 16 may not be employed, exhibited, used, or trained for exhibition in the following occupations:

  • As a rope or wirewalker, gymnast, wrestler, contortionist, stunt rider, or acrobat on a bicycle or other similar vehicle or contrivance.
  • In any illegal, indecent, or immoral exhibition or practice.
  • In an exhibition as insane or idiotic or when presenting the appearance of any deformity or unnatural physical formation or development.
  • In any practice, exhibition, or place considered to be dangerous or injurious to the minor.

Permitted Employment

Employment of minors 16 or older who are enrolled in or have completed an accredited nautical science-training program upon a vessel that is documented or registered under the laws of the United States is permitted.

Hours of Employment

Minors 14 and 15 may be employed after school hours and during nonschool days. Additionally, minors under 16 may not be employed under the following criteria:

  • More than eight hours in any one day.
  • More than six consecutive days or 40 hours in one week.
  • More than three hours on any school day.
  • More than 18 hours in any one school week.

The school calendar of the school in which the minor is enrolled or the public school calendar for the district in which the minor resides is used to determine a school day or week.

Minors who have not graduated from high school are bound by the following provisions:

  • Minors under age 16 may not be employed between the hours of 7 p.m. and 7 a.m.; except from June 1st through Labor Day at which time the permissible hours are extended to 9 p.m. Minors who are employed in the dairy industry are exempt from this restriction.
  • Minors 16 years of age may not be employed between the hours of 11 p.m. and 5 a.m. prior to the start of any school day.
  • Minors 17 years of age may not be employed between the hours of 12 a.m. and 5 a.m. prior to the start of any school day.

Additionally, a minor who has taken and passed a General Education Development test (GED) and who has been awarded a high school Equivalency Diploma from the Louisiana Department of Education will be considered to have graduated from high school.

Note: Employment of minors also is subject to the provisions of any local curfew ordinance.

Meal Periods

No minor may be employed for any five-hour period without one interval of at least 30 minutes for meals. If the period of work before the interval exceeds five hours by 10 minutes or less, that difference is considered de minimis and not a violation of the law. The interval may not be included as part of the working hours of the day and the interval must be 30 minutes.

If the length of the meal break is at least 20 minutes, the difference between the actual break time and the required 30-minute break time is considered de minimis, and is not considered a violation of the law. The break must be documented, using the employer’s normal timekeeping system. If a minor fails to clock in or out for a work period or meal break, and a time edit is necessary, the time edit must be documented and acknowledged in writing by the minor and the manager who performs the time edit.

Presumption of Employment

The presence of any minor under 16 in any place of employment prohibited to the minor and observed to be performing work duties on the employer’s behalf constitutes prima facie evidence of the minor’s employment therein.

Employment Certificates

An employer of minors must keep on file an employment certificate for each minor, except for those minors employed in approved federally funded youth training programs and those minors employed in theatrical, modeling, motion picture or television production, musical occupations, or in other performing arts. The certificate must be accessible on the jobsite at all times and available to any officer charged with the enforcement of Louisiana’s child labor law.

Employment certificates will be issued upon the application by the minor desiring employment along with a written permission from the minor’s parent or legal guardian. The issuing officer must approve the following papers before issuing a certificate:

  • A signed statement from the prospective employer stating the nature of the occupation, the number of hours per day and per week, and the wages the minor is to receive.
  • One of the following proofs of age:
    • Birth certificate.
    • Baptismal certificate.
    • Contemporaneous bible record of birth.
    • Passport or certificate of arrival in the United States showing the age, dated at least two years prior to the application date.
    • Life insurance policy covering the minor, dated at least two years prior to the application date.
    • School record or school identification showing the minor’s age.
    • Current valid Louisiana driver’s license or other state-issued identification, including a special identification card, with the minor’s date of birth.
    • An affidavit signed by the minor’s parent or legal guardian showing the minor’s name, date and place of birth, and a statement that no other proofs of age can be produced.

Employment certificates, including those for home study students, may be issued by any of the following:

  • The parish or city public school superintendent or designated agent.
  • The principal of a public or private school or designated representative.

If the student is a home study program participant, the employment certificate may be issued by any person authorized by the Louisiana Workforce Commission.

The superintendent of the parish, city, or other public school governing authority or a designee, or the private school principal or a designee, must completely fill out and electronically submit the Employment Certificate Interactive Form located on the Louisiana Workforce Commission’s website. The online employment certificate, which includes the information that was entered onto the Department of Labor’s employment certificate database, is to be printed, signed by the minor and the issuing authority, and presented to the minor for delivery to the employer. The employment certificate must be signed by the minor in the presence of the issuing authority and then it must be returned to the minor for delivery to the employer. An employment certificate is valid only for the employer for whom issued, and the employer is required to maintain it on file for a period of 14 days after the minor’s termination of the employment.

Under certain circumstances, such as athletic events, exhibitions, fairs, carnivals, or similar events, the Assistant Secretary of the Office of Regulatory Services may authorize the issuance of a blanket work permit. Blanket permits expire 60 days after issuance.

Recordkeeping Requirements

Every employer of a minor must keep on file an employment certificate or work permit for each minor, except for those employed in approved federally funded youth training programs and those minors employed in theatrical, modeling, motion picture or television production, musical occupations, or in other performing arts. The certificate or permit must be accessible on the jobsite or in the immediate area of the work location at all times and available to any officer charged with the enforcement of Louisiana’s child labor law.

The executive director or authorized representatives may have access to the employment certificates kept on file by the employer as well as all other records that may aid in the enforcement of the child labor law.

Notice Requirements

Every employer must keep conspicuously posted in the establishment a printed abstract of Louisiana’s child labor law and a list of the occupations prohibited to minors. The Executive Director of the Louisiana Workforce Commission may furnish these abstracts.


The executive director or an authorized representative will visit and inspect — at all reasonable times and as often as possible — all places where minors are employed. The secretary or authorized representative may have access to the employment certificates kept on file by the employer as well as all other records that may aid in the enforcement of the child labor law.


Any person who violates Louisiana’s child labor law by refusing to allow inspection of the workplace, obstructing enforcement of the law, hiding minors, or helping them escape from a law enforcement officer will be fined between $100 and $500, imprisoned between 30 days and six months, or both. In addition to criminal penalties, anyone who violates the state’s child labor law will be liable for a civil penalty of up to $500. Each day in which a violation continues and each minor employed illegally constitutes a separate offense.

Any talent agent or person who employs, exhibits, uses, or trains for the purpose of exhibition, or who consents or neglects to restrain a minor from engaging in theatrical employment illegally will be guilty of contributing to the delinquency of minors. Upon conviction, such a person will be fined up to $1,000, imprisoned for up to two years, or both and will be liable for a civil penalty of up to $500.

Employers who unlawfully hire minors under 18 to drive school buses will be fined between $25 and $500, imprisoned for up to six months, or both.

Child Performer Trust Act

The Child Performer Trust Act (located at La. Stat. Ann. §§ 51:2131 – 2135) applies to any contract in which a minor is employed or agrees to render artistic or creative services for compensation of $500 or more in Louisiana, which is not otherwise prohibited by law, directly or through a third-party individual or personal services corporation, a loan-out company, or through an agency or service that provides artistic or creative services including, but not limited to, a casting agency or other similar entity.

Artistic or creative services include, but are not limited to, the following services:

  • Actor or actress.
  • Dancer, musician, comedian, or singer.
  • Stunt person or voice-over artist.
  • Any other performer or entertainer in any motion picture, television, radio, theatrical, or sports production or commercial production.

Every contract executed by or on behalf of a minor rendering artistic or creative services for compensation must require that 15 percent of the gross earnings for the minor, under the contract, be placed in a trust fund created for the minor’s benefit. Prior to the execution of any such contract the trust must be established, unless an account was previously established, and the trustee must provide the employer with a written statement that includes the particulars of the trust. Employers may require more information from the trustee prior to executing the minor’s contract.

In the event that a trust account was not established on behalf of a minor performer within 30 days of the last day of employment, the employer must forward the 15 percent of the minor’s gross earnings, accompanied by the name of the minor, and, if known, the minor’s address and Social Security number, to the Louisiana Treasurer, who will hold the funds in trust to be transferred to a trust account that is subsequently established on behalf of the minor. However, if no such trust account is established, the minor will receive the trust monies upon reaching age 18. After completing the transfer to the treasurer, the employer has no further duty or obligation with respect to the transferred monies.

Education Requirement

Every contract or employment arrangement agreed to by parties subject to the Child Performer Trust Act must include provisions for the education of the minor being employed to render artistic or creative services. If a minor is absent from school for two or more days within a 30-day period, the employer must do the following:

  • Employ a certified teacher beginning on the second day of employment.
  • Ensure that the teacher provide a minimum of three education instruction hours per day to the minor, pursuant to the lesson plans for the particular minor, as provided by the principal and teachers at the minor’s school.
  • Ensure that there is a teacher-to-student ratio of one teacher for every 10 students.

Note: No minors’ employment regulated under the Child Performer Trust Act may occur without the issuance of a written permit from the Louisiana Workforce Commission.

Contact Information

Louisiana Workforce Commission

Affordable Care? 2017 Rates are Out Now!


Here is a personal look at the impact of the impact the Affordable Care Act has had on me and my family.  For reference, in the beginning of 2016, I was 45, my wife 42 and my kids 13, 10 and 5.  Unfortunately, we are all a year older going into 2017.

I am using Blue Cross of Louisiana’s most popular Gold-level plan for my unsubsidized premium comparison.  The plan has a $1,000 deductible ($3,000 for the family) and and out of pocket maximum of $5,000 going down to $4,800 in 2017 ($10,000 going down to $9,600 in 2017 for the family).

  • 2016 Premiums – $1,583.70 per month or $19,004.40 for the year
  • 2017 Premiums – $2,023.05 per month or $24,276.60 for the year

That is an increase of $439.35 per month or $5,272.20 for the year.  It also represents a 27% rate increase.  OUCH!!!

My wife and I both work (pretty hard, I might add).  To be fair, if our combined income was lower, we would qualify for some help with this premium.  You can check your own subsidy availability here.  At $113,000 in combined family income, we would qualify for $303/month in help.  At $114,000 or more, we do not qualify for any help.  I think this is what President Clinton referred to as “the craziest thing in the world.”

Some more broad trends of note:

  • the % increase on some “more affordable” plans (silver and bronze level) is as much as 44%
  • there are more “narrow network” plans this year – both in total number and more drastically in % of total plans available.
  • comparable small group plans are significantly better priced and offer significantly more coverage options.  See – The Small Business Health Insurance Roller Coaster – What is Next? – If you have a business or influence with your small employer, it may be time to run some numbers.

I hope our next President and Congress work together for a better solution for all of our sake. This is not sustainable.


The Small Business Health Insurance Roller Coaster – What is Next?

I have spent my entire 24 year career helping employers shop for, buy and manage their employee benefits.  In that time, the vast majority of large employers (50+ employees – for this discussion) have offered (and plan to continue to offer) their employees health insurance.  In 2010, the Affordable Care Act introduced new incentives (see employer shared responsibility penalties) to make sure that continues.  So far, it looks like that is happening as expected.

However, the small employer market (under 50 employees – not subject to employer mandate) has been much more volatile over the last 15 years.  That volatility has intensified in recent years. – peaking at 66% in 2010 and then bottoming out at 52% just 4 years later.



Why has this happened and what does the future hold for small employers?

For small businesses, the initial decision to offer benefits is almost always driven by a key employee/employees who push the issue with the business owner.  Leading up to the 2010 passage of the Affordable Care Act, every news organization, talk show, politician, etc. talked about healthcare and health reform in some form just about every day. So, naturally, employees who had not thought about it before, were now asking about it.  Employers who hadn’t offered coverage before decided to make an offer for the first time.

This led to an almost 10% jump in firms offering health benefits from 2009 to 2010.  But, that increase completely vanished in 2011.  And, over the following years, the trend to away from group insurance increased as the % of firms offering health benefits reached a 15+ year low in 2014.

For employers with a higher percentage of low income employees, the move away from group insurance may continue.  This is because these employers cannot (and do not want to) compete financially with the subsidy available to low income employees.  Here is an example of how income impacts an individual’s coverage choices:

An unmarried 40 year old with 2 children under 18 years old can expect to pay about $391/month for herself or about $779/month for her and her children with no subsidy or medicaid available. She will also have the following subsidy options at different income levels:
Household Income Medicaid? Subsidy – Net cost
$25,000 Yes – entire family None – $0/month
$35,000 Yes – children only $180/month – $211/month
$45,000 Yes – children only $59/month – $332/month
$55,000 No $254/month – $525/month
$65,000 No $138/month – $641/month
$75,000 No $57/month – $722/month
$85,000 No None – $779/month

However, I expect that employers with higher-paid and geographically diverse employees will see that trend of moving away from group coverage reverse considerably.  This has already started and will accelerate very quickly.  Here are the 3 main drivers of that move:

  • Taxation of Employer Contribution to Individual Plans – In an updated Q&A about the practice of reimbursing individual health premiums, the IRS Q&A warns: “such an arrangement fails to satisfy the market reforms and may be subject to a $100/day excise tax per applicable employee (which is $36,500 per year, per employee) under section 4980D of the Internal Revenue Code.”  Though there are pockets that disagree with this interpretation and are fighting for a change, most have come to grips that it is best to avoid the practice rather than risk penalties.
  • Implosion of the Individual Health Insurance Market – Just about every carrier that has offered products on the individual exchange has lost money.  Some have lost so much money, they have decided to get out of the exchanges altogether.  The carriers that have remained have increased their prices significantly while drastically limiting their product offering – eliminating platinum-level plans, restricting the number of zip codes that they offer policies AND introducing more and more “narrow” network options.
  • Small Group Relative Stability – Trend price increases for small group (and group in general) have been modest in comparison to what we were seeing a few years back (pre-ACA) AND are modest compared to increases we have seen and expect to see in the individual market. In addition, there are now considerably more plan options to choose from in group vs. individual.  And finally, the price of comparable group plans are less than individual plans with similar benefit levels.

Individuals who are not eligible for subsidies because of their income will discover this discrepancy and push for change from their employer.  It will start with the business owner who is just a phone call or email away from discovering what this means to them and their families.

If you own a small business and want to see how all of this impacts you, your family and your employees we are always here to help.