Course Description
This fiduciary training program provides an in-depth overview of ERISA fiduciary obligations and emerging litigation risks for welfare benefit plans. It covers the core duties imposed on fiduciaries, including prudence, loyalty, and adherence to plan terms, and explains how these duties apply in areas such as PBM contracting, wellness programs, and claims administration. The program highlights recent trends in fiduciary litigation, transparency requirements under the Consolidated Appropriations Act, and strategies for mitigating liability through prudent processes, documentation, and governance. Participants will leave with actionable best practices to strengthen fiduciary compliance and reduce exposure to costly lawsuits.
Principles
- Definition and Roles of Fiduciaries under ERISA
- Core Fiduciary Duties
- Claims and Appeals Procedures
- Fiduciary Litigation Trends
- Transparency Rules under CAA
- PBM Compensation Models
- Tobacco Surcharge and Wellness Program Compliance
- Controlling Fiduciary Liability
Syllabus
- Definition and Roles of Fiduciaries under ERISA
- Who qualifies as a fiduciary and the importance of “which hat you are wearing.”
- Core Fiduciary Duties
- Exclusive Benefit, Prudent Expert, Plan Adherence, Disclosure, and Duty to Monitor.
- Claims and Appeals Procedures
- Legal requirements and litigation risk mitigation.
- Fiduciary Litigation Trends
- Welfare fee litigation, PBM-related lawsuits, and new theories (e.g., plan structure challenges).
- Transparency Rules under CAA
- Fee disclosures, price comparison tools, machine-readable files, gag clause prohibition.
- PBM Compensation Models
- Spread pricing, rebates, and conflicts of interest.
- Tobacco Surcharge and Wellness Program Compliance
- HIPAA rules, incentive limits, and litigation risks.
- Controlling Fiduciary Liability
- Appointment procedures, insurance, indemnification, vendor selection, and documentation best practices.
