CEBS cheat sheet

ERISA requires a written plan document and a Summary Plan Description; the SPD must be furnished within 120 days of a new plan's effective date and within 90 days after a participant enters the plan.

COBRA applies to employers with 20 or more employees; qualifying events carry 18 months of continuation (termination, reduced hours) or up to 36 months (death, divorce, Medicare entitlement), with a 60-day election window.

HIPAA special enrollment gives 30 days after marriage, birth, or adoption and 60 days after loss of other coverage; preexisting condition exclusions are prohibited for all group health plans.

For employers with 20 or more employees, the group health plan is primary and Medicare secondary for active employees and spouses aged 65 and older.

ACA non-grandfathered plans must cover preventive services at 100%, extend dependent coverage to age 26, ban annual and lifetime dollar limits on essential health benefits, and cap out-of-pocket spending ($9,200 individual / $18,400 family for 2025).

The ACA limits group health eligibility waiting periods to 90 days; Canadian group plans commonly use a 3-month waiting period for extended health and dental.

Canada's provinces administer publicly funded coverage for medically necessary hospital and physician services; employer plans layer extended health, prescription drug, dental, and paramedical coverage on top.

Canada's Employment Insurance pays 55% of insurable earnings for up to 26 weeks of sickness benefits after a one-week waiting period; CPP/QPP retirement benefits replace 25% of the YMPE at normal retirement age of 65.

Self-funded plans operate under ERISA preemption, avoiding state premium taxes and state benefit mandates, but require stop-loss coverage and careful claims-reserve management.

Stop-loss structure: a specific deductible per claimant plus an aggregate attachment point (often near 125% of expected claims); contracts are written on 12/12 or 15/12 basis for run-out protection.

HSA eligibility requires qualifying high-deductible coverage, no disqualifying coverage, no Medicare enrollment, and dependent status; 2025 limits are $4,300 individual / $8,550 family with a $1,000 catch-up at age 55.

Health FSA salary reduction limit is $3,300 for 2025; unused balances are forfeited unless the plan adopts a carryover of up to $660 or a grace period of up to 2.5 months.

FMLA covers private employers with 50 or more employees within 75 miles and provides up to 12 weeks of unpaid, job-protected leave per 12-month period with continued group health coverage.

Disability benefits are taxable to the employee when the employer pays the premium and tax-free when the employee pays with after-tax dollars; LTD commonly replaces 50%–60% of pay after a 90–180 day elimination period.

Canadian group drug plans manage cost through provincial formularies, generic substitution, prior authorization, and dispensing-fee caps, while the PMPRB regulates patented drug prices.

Canadian LTD generally replaces 60%–70% of pre-disability earnings, uses own-occupation for about 24 months and any-occupation thereafter, and integrates with CPP disability and WSIB benefits.

Benefits strategy is framed against a total rewards philosophy and competitor market position, selected by benchmarking percentile: 50th for median practice, 75th to lead the market for critical roles.

Core cost metrics include cost per employee, cost per FTE, plan loss ratio (incurred claims divided by premium or contributions), and annual trend rate compared with general inflation.

Value-on-investment analysis compares the perceived value of a benefit with its cost per employee, and is used to decide whether to retain, redesign, or eliminate a program.

Vendor selection follows a documented RFP process with evaluation criteria, performance standards, and performance guarantees; ERISA section 408(b)(2) requires covered service providers to disclose fees in writing to the fiduciary.

ERISA welfare and pension plans with 100 or more participants generally must file Form 5500 annually, reporting financial condition, operations, and participant counts.

Canada's CAPSA CAP Guidelines require sponsors of member-directed defined contribution plans to deliver investment information, offer a suitable fund lineup, and monitor investment performance.

Canadian plan environment: provincial employment standards, human rights legislation requiring accommodation, pay equity rules, and provincial or federal pension standards legislation shape plan design and administration.

Open enrollment effectiveness is measured by enrollment mix shifts, plan literacy scores, and call-center volume rather than by communication volume alone.

Qualification under IRC 401(a) requires a trust for the exclusive benefit of participants, coverage testing under 410(b), nondiscrimination testing under 401(a)(4), and top-heavy testing under 416.

2025 U.S. limits: elective deferrals $23,500; age-50 catch-up $7,500; SECURE 2.0 age 60–63 catch-up $11,250; 415(c) annual additions $70,000; 401(a)(17) compensation cap $350,000.

ADP and ACP tests compare highly compensated and non-highly compensated employees; safe harbor designs (3% nonelective or basic match) are deemed to pass and also exempt the plan from top-heavy minimums.

Vesting: employee deferrals are always 100% vested immediately; employer matching contributions may use a 3-year cliff or 2-to-6-year graded schedule, with faster schedules required in top-heavy plans.

Distributions before age 59½ generally incur a 10% additional tax unless an exception applies; required minimum distributions begin at age 73 under SECURE 2.0, and Roth accounts have no lifetime RMD for the owner.

2025 Canada limits: RRSP dollar limit $32,490 (or 18% of prior-year earned income, less pension adjustment); TFSA annual limit $7,000; DCPP money purchase limit matches the RRSP limit.

CPP 2025: Year's Maximum Pensionable Earnings $71,300 and Year's Additional Maximum Pensionable Earnings $81,200, reflecting the enhanced CPP's first and second additional contribution tiers.

Defined benefit funding under PPA uses the funding target, target normal cost, and seven-year amortization of shortfalls, with quarterly contribution requirements and at-risk rules for underfunded plans.

PBGC premiums consist of a flat per-participant rate plus a variable-rate premium assessed on unfunded vested benefits for single-employer plans.

Fiduciary roles: ERISA section 3(21) investment advisors provide recommendations, while 3(38) investment managers take discretionary authority; ERISA 404(c) shields fiduciaries when participants direct investments from a broad menu with required disclosures.

Participant fee disclosure under 404a-5 must show plan-related and investment-related fees, including expense ratios, recordkeeping charges, and individual transaction fees.

Participant loans are limited to the lesser of $50,000 (reduced by the highest outstanding balance in the prior 12 months) or 50% of the vested account balance, with level amortization at least quarterly.

Hardship distributions are limited to employee deferrals and safe-harbor events such as medical expenses, tuition, eviction or foreclosure prevention, and casualty loss, capped at the amount of demonstrated need.

Canadian DB funding uses both a going-concern valuation and a solvency valuation; solvency deficiencies are funded over a prescribed period, and Ontario and Quebec operate pension benefits guarantee funds.

Canadian decumulation options include RRIFs with prescribed minimum withdrawals (age 71 factor 5.28%), life income funds for locked-in money, and annuity purchases that transfer longevity and investment risk to the insurer.