Smart Benefits: Are You Audit-Ready?

Rob Calise, GoLocalProv Business/Health Expert

Smart Benefits: Are You Audit-Ready?

The Department of Labor (DOL) has the authority to investigate employer-sponsored health plans for compliance with the ACA. And employers who fail an audit can face corrective action and steep penalties.

As the DOL steps up its enforcement efforts, more and more companies will receive a notice of audit and data request letter. The notice will ask for materials such as plan documents, amendments, summary plan descriptions, summary of benefits and coverage, participant notices, and contracts with insurers and service providers. 

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Before a letter arrives, there are several steps employers can take to prepare for an investigation and demonstrate compliance:

  • Issue required notices to participants in a timely manner 
  • Update plan documents and summary benefit descriptions as plans change
  • Respond to participant questions and information requests promptly
  • Maintain complete and accurate records
  • File Form 5500 accurately and on time

Utilize the DOL’s self-compliance tool to understand some group health plan responsibilities under the ACA and periodically perform an internal compliance review to identifies any areas for correction.

Rob Calise is a founding partner of Cornerstone Group, where he helps clients control the costs of employee benefits by focusing on consumer driven strategies and on how to best utilize the tax savings tools the government provides. Rob serves as Chairman of the Board of United Benefit Advisors, and is a board member of the Blue Cross & Blue Shield of RI Broker Advisory Board, United HealthCare of New England Broker Advisory Board and Rhode Island Business Healthcare Advisors Council. He is also a member of the National Association of Health Underwriters (NAHU), American Health Insurance Association (AHIA) and the Employers Council on Flexible Compensation (ECFC), as well as various human resource associations. Rob is a graduate of Bryant University with a BS in Finance.

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