60-Second Compliance Check

Is your health plan actually compliant?

Federal Transparency in Coverage rules and ERISA fiduciary duties require self-insured employers to do real oversight — not just trust their TPA or PBM. Answer 7 questions and find out where you stand.

Many plan sponsors have gaps in several of these areas, and ERISA fiduciaries can face personal liability.

7-Question Screening

Answer honestly. Most plans don’t pass.

Each question maps to a documented federal Transparency in Coverage or ERISA fiduciary requirement. “Not Sure” counts as a gap — because under fiduciary review, it is one.

Machine-Readable Files

Has your TPA or carrier given you a written URL where your plan's machine-readable rate files are publicly posted — and have you verified they actually exist and update monthly?

Required under federal Transparency in Coverage rules. Most plan sponsors have never opened the file.

Data Validation

In the last 12 months, has anyone — internal or independent — validated that your MRF data is accurate (not just that the file exists)?

Fiduciaries can't rely on vendor representations alone. The file existing is not the same as the file being right.

Vendor Contracts

Do your TPA, PBM, and broker contracts include written transparency obligations, audit rights, and breach remedies?

If transparency isn't in the contract, you have no enforcement path when the data is wrong.

PBM Audit

Have you exercised your PBM audit rights in the last 18 months, or do you have one scheduled?

Pharmacy spread, rebates, and reimbursement detail are where most plans bleed. If you haven't audited, you don't know.

Financial Reconciliation

Can you reconcile what your plan paid versus what providers and pharmacies were actually reimbursed — including PBM spreads and rebates?

Plan-paid does not equal provider-received. The gap is where indirect compensation hides.

Indirect Compensation

Have you received written 408(b)(2) disclosures of all direct AND indirect compensation paid to your broker, TPA, PBM, and stop-loss carrier in the last year?

Required disclosure. Required review for reasonableness. If you haven't received it, ask — silence is the red flag.

Audit Readiness

If a Department of Labor auditor asked tomorrow, could you produce meeting minutes, vendor performance reports, and a remediation log within 30 days?

Process matters as much as outcome. Fiduciary duty is judged on documented prudent process.