Questions? Contact us at 216-592-2222 or healthcarereform@cose.org.

Since the passage of the Affordable Care Act (ACA) in 2010, employers have had a number of new considerations to make regarding their insurance plans, such as whether or not to offer insurance or which type of plan is best for the employees and the business. While these decisions can often leave your head spinning, there’s another element to consider as you think about your health insurance plan today and going forward.

Housed within the U.S. Department of Labor (DOL) is a division called the Employee Benefits Security Administration (EBSA), which is charged with enforcing the Employee Retirement Income Security Act of 1974 (ERISA) and a myriad of other federal laws and regulations governing employee benefit plans. With all the changes that have been implemented as a result of the ACA, this division is now also working to ensure that employers – large and small – are compliant with the new rules and regulations governing employer-sponsored insurance plans. Their efforts to enforce compliance include the administration of audits on companies to ensure they are operating according to the new health care law's rules and regulations.

What's covered in an audit?

There is a slew of information to provide in the case that you are audited by the Department of Labor. A small sample of information requested during an audit includes:

  • Communication of the extension of benefits to age 26
  • Communication of women’s health rights
  • Availability of a Summary Plan Description
  • Confirmation of the plan’s Grandfathered status, if applicable
  • A copy of the employee enrollment application
  • Documents that describe the responsibilities of the employer and employees regarding the payment of the costs associated with the purchase and maintenance of health and welfare benefits

What to do if you receive notice of an audit

If you receive notification that the DOL is planning to audit your health insurance plan, there are a handful of immediate actions you should take in order to prepare.

  1. Notify your broker or your group service representative. They will make sure that you have the information you need to provide the DOL with assurance that you are in compliance with the law. 
  2. Review the requirements included in the letter you received from the DOL to begin identifying areas where you have information and those where you need further data  
  3. Cooperate with the DOL during the audit by providing them with the information they are requesting

Proactively preparing for an audit

Demonstrating compliance with ACA is critical for employers of all sizes, regardless of whether they are fully-insured or self-insured. Make your life easier by taking the appropriate measures to ensure that you have your ducks in a row prior to receiving any audit notification from the DOL. To do this, COSE recommends designating someone on staff to be on point for all health insurance related information. In addition, ensure that all the information related to your health insurance plan is kept in one location that's easily accessible to those on staff who may need it during an audit.

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