Compliance Legislation Strategy

Coverage Highlights

The United States Department of Labor (DOL) has shifted their auditing focus to group health and welfare benefits plans.  In the past, it was common to expect oversight of pension and 401(k) plans but now with healthcare reform health and welfare plans are also being looked at.  It is prudent to be aware of documents the DOL may ask for in the event of an audit in order to ensure compliance and alleviate the risk of penalties.

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Audit preparation considerations include an ERISA-compliant plan document and a summary plan description that describes the terms of the plan (eligibility, benefits, etc.). Another measure that reduces audit exposure is good record-keeping that allows organized reference to all insurance contracts and, if your plan is self-insured, all contracts for claims processing, administrative services, and reinsurance.

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Employers are advised to have current documents available that describe the responsibilities of both the employer and employee with respect to the payment of the costs associated with the purchase of health and welfare benefits.  In accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), there are a number of documents auditors may request access to:

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• Plan rules for enrollment eligibility and terms

• Example of the HIPAA certification provided to employees upon loss of coverage

• Records/logs of all Certificates of Creditable Coverage for individuals who lost coverage under the employer group plan or who have requested certificates

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There are several more areas that fall under the HIPAA umbrella that should be accessible to demonstrate compliance, such as plan rules regarding coverage of medical/surgical and mental health benefits, the Newborns’ Act notice, information on rules in connection with childbirth, and the Women’s Health and Cancer Rights Act.

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Maintaining health and welfare plan compliance can be challenging for any business.  At Corporate Financial, we stay abreast of regulations and compliance requirements for employee benefits to ensure our clients do too.  Some of the services we provide our clients are:

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• Benefit contract/plan document review

• Health and welfare compliance guidance

• Welfare plan compliance calendar

• Health Care Reform compliance timeline

• Form 5500 preparation