Employers - Be Prepared for ACA, GINA and Wellness Plan Compliance Audits!
Author: Tracy Morley, XpertHR Legal Editor
Updated audit protocols from the Department of Labor's Employee Benefits Security Administration (EBSA) include a review for compliance with the Affordable Care Act (ACA), the Genetic Information Nondiscrimination Act (GINA) and wellness plans. Based on the change in audit protocols, it seems that the EBSA is increasing its review efforts, with a particular focus on compliance with the ACA.
The EBSA examines health plans for compliance with a number of laws, including the Employee Retirement Income Security Act (ERISA), the Health Insurance Portability and Accountability Act (HIPAA), the Women's Health and Cancer Rights Act (WHCRA) and the Consolidated Omnibus Budget Reconciliation Act (COBRA).
As the requirements of the ACA continue to phase in, the EBSA audits will look to ensure compliance with a number of its provisions and, among other things, will be looking for documentation regarding the plans':
- Grandfathered status;
- Enrollment opportunities for adult dependent children;
- Internal claims and appeals procedures; and
- Lifetime and annual limits.
Additionally, in order to ensure compliance with HIPAA and GINA, an audit may include a review of the design of wellness programs offered by the plan, as well as disclosure notices required to be provided with reward-based programs.
Employers should take the opportunity to conduct a thorough review of their health plans. While there seems to be an increased focus by the EBSA to ensure compliance with health care reform provisions, employers should not neglect compliance efforts associated with other laws enforced by the EBSA, such as ERISA and COBRA.
Additional Resources
Health Care Reform Resource Center
Employee Benefits > Managing Health Care Costs > Wellness and Prevention Programs
Employee Benefits > Compliance, Reporting and Disclosure Requirements
Employee Benefits > Health Information and Privacy (HIPAA)
Employee Management > EEO - Discrimination > Genetic Information Nondiscrimination Act