New Year, New Benefits: 12 Days of Compliance

Angela Surra

Angela Surra

Happy New Year! Or, more accurately, Happy New Plan Year! After successfully leading your organization through benefits open/annual enrollment last fall, you deserve a toast to the start of the plan year—generally, January 1 for many employer-sponsored plans. However, as you celebrate, be sure to clink your glass to compliance as well. In the spirit of the season, here’s a “12 Days of Compliance” checklist to help you end 2023 and plan for a successful 2024.

1. Ensure Employee Retirement Income Security Act (ERISA) compliance

  • Update the plan document with any renewal changes.
  • Provide enrolled employees with an updated Summary Plan Description (SPD) or an added Summary of Material Modifications (SMM) to the existing SPD.
  • Ensure ERISA notices are distributed according to ERISA distribution rules.

2. Affirm Affordable Care Act (ACA) compliance

  • Provide a Summary of Benefits and Coverage (SBC) to benefits-eligible employees.
  • Distribute the Uniform Glossary and any other required ACA notices.
  • Stay vigilant about any changes in ACA regulations that may affect your benefits offerings.

3. Honor Health Insurance Portability and Accountability Act (HIPAA) compliance

  • Provide the required notices of patient protections and special enrollment rights under HIPAA.
  • Regularly review and update privacy and security measures to safeguard protected health information (PHI).

4. Secure state and local compliance

  • Research and comply with additional requirements mandated by local and state laws.

5. Archive activities and acknowledgments

  • Keep thorough records of all compliance-related activities, including notices sent and acknowledgments received.

6. Deliver annual notices

  • Include the required notices under the Newborns’ and Mothers’ Health Protection Act.
  • Disclose any applicable grandfathered plan status.
  • Comply with the Children’s Health Insurance Program (CHIP) notice requirements.
  • Include applicable wellness program notices.
  • Adhere to the Women’s Health and Cancer Rights Act requirements.

7. Double check demographic and dependent data

  • Confirm that employee names and demographic information are accurate across all files and systems, especially in the payroll system.
  • Regularly update and validate dependent information to avoid discrepancies.
  • Encourage employees to promptly report any changes in personal or dependent information.
  • Establish a data governance framework to maintain data integrity.
  • Consider periodic data audits to proactively identify and address inaccuracies.

8. Ensure election accuracy

  • Verify that employee elections transferred or sent to carriers align accurately with their choices during open enrollment.
  • Ensure that updated deductions in the payroll system match employee benefit elections.

9. Catalog carrier invoices

  • Set a regular schedule for reviewing all carrier invoices to promptly identify and rectify any discrepancies.

10. Delve into dependent eligibility

  • Establish a detailed process and timeline for conducting dependent eligibility audits.
  • Communicate the audit details to employees in advance, adhering to relevant laws like ACA and COBRA.
  • Clearly communicate results to employees and outline next steps for ineligible dependents.

11. Prepare plan adjustments

  • Analyze data on benefit plan participation to inform future planning and adjustments.
  • Identify trends in benefit plan selection to tailor offerings for the next enrollment period.

12. Tap into technology

  • Leverage technology solutions for data validation and accuracy checks.
  • Explore automation options for routine data verification processes.

By now, you’ve likely noticed there’s no partridge or pear tree! But by taking this list and checking it twice, you can begin 2024 on solid ground with HR and compliance—and that’s something to celebrate year-round.

Author: Angela Surra
About
Angela Surra, CIC, CISR, SHRM-CP is the Principal Benefits Expert at Mineral