60-Second Compliance Check

Where does your health plan need a closer look?

Federal transparency rules create disclosure and data-access requirements, while ERISA requires plan fiduciaries to follow a prudent process. Answer 7 questions to identify areas worth verifying with your TPA, PBM, and qualified advisors.

ERISA fiduciaries may be personally liable for losses caused by a fiduciary breach; whether that applies depends on the person’s role and the facts.

Federal sources used for this educational screening:

Sources last reviewed August 29, 2026. This screening is educational, not a legal determination or substitute for advice from qualified ERISA counsel.

7-Question Screening

Answer what you know. Flag what needs follow-up.

These questions mix specific federal transparency topics with optional governance practices. A “No” or “Not Sure” answer identifies a topic to discuss with your vendors and qualified advisors; it does not establish noncompliance.

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?

Federal Transparency in Coverage rules require specified pricing disclosures in machine-readable files. Confirm the rule's scope and your plan's compliance with qualified advisors.

Data Validation

Does your plan have a documented process for checking whether its machine-readable files are complete and usable, not just present?

Governance practice, not a universal federal validation schedule: decide with your advisors what review is appropriate for your plan.

Vendor Contracts

Have qualified advisors reviewed your TPA, PBM, and broker contracts for prohibited data-access restrictions and explained your available audit or enforcement rights?

The CAA prohibits specified gag clauses. Audit rights and remedies depend on the agreement and applicable law.

PBM Audit

Does your plan have a documented process for reviewing PBM reports, compensation, rebates, and whether an audit is warranted?

Governance practice, not a universal federal audit interval: the appropriate review depends on your contracts, plan, and facts.

Financial Reconciliation

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

Governance practice: reconciliation may help a plan understand fees and compensation, but the appropriate scope is fact-specific.

Indirect Compensation

Has your plan identified which service providers are subject to ERISA section 408(b)(2) disclosure rules and reviewed any required disclosures with qualified counsel?

Legal requirement where applicable: coverage depends on the provider, service, compensation, contract, and current federal rules.

Audit Readiness

Can your team locate the records it uses to evaluate plan vendors and material plan decisions?

Governance practice: documentation can help show the process followed. The cited federal guidance does not set a universal 30-day production deadline.