We all knew it was coming — the feds auditing companies to make sure they were in compliance with all the various mandates of the health care reform law. Are you prepared to stave off any reform audits should the DOL come knocking? Here’s what you’ll need.
DOL audit letters updated to gauge compliance with the health care reform law are starting to find their way into the hands of plan sponsors.
If you don’t have these documents in order, now’s the time to get them ready should your plan ever be audited:
For all plans
There are certain provisions that both non-grandfathered and grandfathered health plans must comply with, and they will be required to show the following documents:
- Samples of the written notice describing the opportunity for employees to enroll their dependent children up to age 26
- A list of individuals whose coverage has been rescinded, a listing of the reasons why and copies of the recession notices
- Copies of all notices relating to lifetime or annual limits, or the elimination of those limits, and
- If applicable, samples of all notices sent to participants stating that the lifetime limit on the dollar value of all benefits no longer applies.
For grandfathered plans
As you know, a grandfathered health plan is one that was in place as of March 23, 2010 (the day the health care reform law went into effect).
Grandfathered plans facing a DOL audit will need to furnish a number of documents to validate that status. Such as:
- A copy of the “grandfathered health plan status disclosure statement”
- Records showing the terms of the plan as of March 23, 2010, and
- Documents verifying, explaining or clarifying the plan’s status as a grandfathered health plan. These include terms of cost sharing, contribution rates, annual and lifetime limits on benefits, and any contract with a health insurance issuer in effect on March 23, 2010.
Most plans will fall into this category, and they’ll be required to produce:
- Copies of the plan’s notices informing participants of the right to designate a primary physician, along with a list of participants who received the notices
- Documents explaining the process and procedure for administering external appeals, as well as a contract showing the hiring of an external appeals administrator and the process for evaluating that administrator, and
- Copies of the last five appeals filed after Sept. 23, 2010, with all the information relating to the highest level appeal that was completed.
In addition, there may also be a request for all documents issued in a non-English language, which are required in counties in which 10% or more of the population speaks the same non-English language.