Is your health plan out of compliance? 4 areas to check ASAP

by Jared Bilski

The sheer complexity of changing federal regs as well as the impact of recent landmark court rulings on benefits plans make assessing health-plan compliance a critical task that HR pros need to put at the top of their to-do list.

In fact, ERISA attorney Daniel N. Kuperstein is warning employers everywhere that most health plans aren’t fully compliant with the host of regs they’re subject to.

Almighty plan document

A proper assessment of your health plan starts with the plan document, Kuperstein says. Simply put: If your plan doc doesn’t gibe with how your benefits are actually provided to employees, you’re out of compliance.

Well-meaning employers will often get themselves into trouble by offering benefits and perks that aren’t detailed in the company’s plan document.

On top of an up-to-date plan document, employers have to make sure none of the language in their summary plan descriptions, benefits-related policies and benefits communications contradicts what’s written in the official plan document.

Some specific documents employers will want to review include: Employee notices, COBRA offerings and documents, FMLA info and health plan non-discrimination testing.

For a sample health plan compliance assessment checklist, visit. In addition, here are some major changes in the benefits world to keep in mind when it comes to compliance:

1. The ever-changing ACA regs

In this year alone, the feds clarified and changed several key aspects related to health reform reporting (e.g., COBRA coverage). Not being up to speed on even minor changes to the reporting rules can lead to costly mistakes (a $250 per return penalty up to a $3 million max).

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