Pre-Tax Documents

 Premium Conversion Plan Document

DOL Notices 

 Wrap Plan Document

 Wrap Summary Plan Description (SPD)

 Guidelines for Distribution

 Employee Acknowledgment of Receipt of SPD

CHIP Notice

Noticia CHIP

 FMLA Fact Sheet

 FMLA Employee Rights and Responsibilities

 ADA Fact Sheet

 FLSA Facts

 Premium Conversion Plan SPD


Employee Acknowledgment of Receipt of SPD - Spanish

FMLA Poster

 Model Exchange Notice - Spanish


 Compliance Documents


Pre-Tax Documents

  Case Benefit Consultants provides a Premium Conversion Plan to eligible employees. This plan enables eligible employees to elect to receive part of their compensation in the form of pre-tax benefits. See attached summary plan description and election form for more information.

The Premium Conversion Plan is an Internal Revenue Service (IRS) plan document filed as a Section 125. The (IRS) states that eligible employees may only make elections to the plan during their initial eligibility period, or once a year at open enrollment. Pre-tax benefit choices are binding through the end of the plan year, which is currently August 31. The following circumstances are some examples of allowable changes you can make during the plan year:

 - Marriage or Divorce
 - Birth or Adoption
- Death of a Dependent
 - Loss of Dependent Status
- Loss of spouse's job where coverage is maintained through his/her employer plan

DOL Notices

The Summary Plan Description (SPD) is a written document that the plan administrator must provide automatically and free of charge to all participants of an ERISA-covered health benefit plan. The SPD explains what coverage the plan offers, how the plan operates, and the rights and responsibilities of participants and beneficiaries. The SPD, in addition to the written plan document, must be provided to all participants. Carrier certificates do not alone satisfy the requirements of the SPD.

For additional information on the SPD and compliance you may refer to the DOL website:

The Wrap SPD document is used to wrap the required ERISA language around a single policy or plan. For example, the Wrap is used to combine the ERISA language with a medical certificate of coverage (or dental, vision, life, disability). Insurance carriers often include state-mandated provisions regarding coverage but do not always include the required federal ERISA requirements.

In addition to the SPD and Wrap SPD we have included the additional notices required by the DOL which include the Federal Exchange Notice, FMLA, FSLA and ADA. The Health Care Reform law also requires you to provide the standardized Summary of benefits and Coverage to all employees enrolled in your employer sponsored group health plan.