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Ask the Experts: Executive-Only Medical Plans

Question: Our company offers group medical and dental plans for all employees. We also have an executive-only medical plan that covers out-of-pocket expenses that the regular group plan does not pay. Does COBRA apply to the executive-only plan? Do we have to include it in our summary plan description (SPD)?

Answer: The coverage continuation requirements of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) pertain to group health plans sponsored by employers with 20 or more workers (except certain church plans). This is referred to as federal COBRA, which is enforced and regulated by the Internal Revenue Service (IRS) and the Department of Labor (DOL).

Any employer-sponsored plan or program providing health benefits (medical, dental, vision, etc.) is a group health plan under COBRA. Briefly, if the employee’s access to the program or benefits is based on the person’s current or past relationship with an employer, it is a group plan. An executive-only medical plan is a group health plan – and subject to COBRA – since eligibility for the plan is connected to employment. (Reference: 26 CFR § 54.4980B-2 )

Next, the Employee Retirement Income Security Act (ERISA) imposes numerous reporting and disclosure requirements on employee benefits plans, including rules for plan documents and summary plan descriptions (SPDs). Plans sponsored by governmental employers and certain church plans are exempt from ERISA, but plans sponsored by private-sector employers must comply with ERISA’s plan document and SPD rules. There is an exception, however, for an executive plan that meets the following conditions:

  • The plan primarily provides welfare (e.g., health) benefits for a select group of management or highly-compensated employees; and
  • No part of the plan is funded through employee contributions or a trust.

The most common example is an executive-only medical insurance plan for which the employer pays 100 percent of premiums. In that case, an SPD is not required and Form 5500 reporting does not apply. A plan document is required but it does not have to be made available to employees. The plan document does have to be provided to the Department of Labor (DOL) if requested. (Reference: 29 CFR § 2520.104-24)

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Kathy Berger
Kathy Berger is ThinkHR’s principal benefits consultant. She is a Certified Employee Benefits Specialist (CEBS) with over 25 years of experience working with brokers and employers. Kathy uses her extensive knowledge of ERISA, HIPAA, the ACA, and other benefits laws and regulations to assist our clients with practical information in clear language.