Employee Health Benefits Annual Review and Compliance
1. Pre-Review Preparation
- Collect plan documents, summary plan descriptions, and amendments.
- Obtain copies of enrollment forms and eligibility criteria.
- Gather information on claims data and utilization reports.
- Ensure access to any vendor contracts and agreements.
- Locate the previous year's audit report.
- Identify key findings and unresolved issues.
- Assess the effectiveness of actions taken in response.
- Document follow-up actions required for outstanding items.
- Identify key personnel from HR, legal, and finance.
- Send invitations to potential team members.
- Outline roles and responsibilities for each team member.
- Confirm participation and availability for meetings.
- Determine the frequency and duration of meetings.
- Create a calendar of meeting dates and times.
- Establish objectives to guide the review process.
- Share meeting agendas in advance with participants.
2. Policy and Plan Document Review
- Review recent changes in healthcare laws.
- Cross-reference documents with regulatory updates.
- Consult legal or compliance team for accuracy.
- Ensure all relevant information is included.
- Assess readability and comprehension of summaries.
- Verify availability in multiple formats.
- Gather employee feedback on clarity.
- Update summaries based on feedback received.
- Monitor government websites for updates.
- Review industry publications for legal changes.
- Document any relevant changes noticed.
- Communicate updates to all stakeholders promptly.
3. Compliance with Regulatory Requirements
- Review current health plans for minimum essential coverage.
- Verify employer shared responsibility payment calculations.
- Ensure proper reporting of health coverage to IRS.
- Audit employee communications regarding health coverage options.
- Examine plan documents for adherence to ERISA standards.
- Ensure timely disclosures are provided to plan participants.
- Confirm that fiduciary responsibilities are being met.
- Review claims and appeals processes for compliance.
- Assess administrative, physical, and technical safeguards.
- Verify training programs for staff on HIPAA regulations.
- Audit access controls to protected health information (PHI).
- Review incident response plans for data breaches.
- Confirm that COBRA notices are sent timely to eligible employees.
- Review continuation coverage options provided to employees.
- Ensure accurate tracking of COBRA premiums and payments.
- Audit compliance with any state-specific COBRA laws.
Use in Manifestly