For an organization to provide health insurance benefits to its employees, it must meet and adhere to certain rules and regulations laid out by both federal and state laws. On occasion, these regulations can change year to year, so it’s important to be aware of these things before enrollment. This ensures employees can get the coverage they need, and the organization does not get fined or deemed ineligible for benefit coverage offerings.
One way to ensure eligibility is by having a benefits compliance checklist. Each year, your organization can go through the list and make any updates to changes, check off that they’ve met the requirements, and add any new regulations to the existing document. We’ve put together a handy checklist that contains a few crucial things that your organization can look for as you approach open enrollment.
Government Mandate Changes and Updates
Rules, regulations, laws, and government mandates can always change. It is essential to confirm or deny what has remained the same and what has changed. For example, in 2020, the dates for open enrollment for a plan via the Affordable Care Act changed to November 1st through December 15th. These dates may change any year, depending on when dates land during the week and other factors.
Affordable Care Act (ACA) Requirements
We recommend that you annually review any regulations to the ACA to confirm if there are any new changes. For example, for plans through 2018, people not enrolled in insurance coverage faced a fee called the Individual Shared Responsibility Provision. This is no longer active for 2019 plans and after, so it will not be applied on any tax forms after 2019.
HIPAA compliance does not just apply to those working in the healthcare field. You will also want to remain HIPAA compliant as confidential data is shared between you and your employees during enrollment. You should ensure the program you use is HIPAA compliant.
HIPAA updates their regulations pretty regularly, depending on new or overturned laws. There are actually quite a few changes up for review this year for HIPAA regulations that you can find discussed here. Things like lessening restrictions on physicians working together to give more affordable care to patients and how substance abuse records are kept and shared amidst a growing opioid crisis.
These changes must be followed closely by those in the healthcare field, but it’s also good to read articles like the HIPAA Journal link we shared to inform any impending changes before open enrollment.
Minimum Essential Coverage Requirements
To be considered legitimate, every plan should include 10 essential services within healthcare. Meeting these minimum essential coverages is very important to ensure security with your employees and remain compliant. Those 10 services include preventative, maternity and newborn, emergency, lab work, mental health, prescriptions, dental and/or vision care, rehabilitative (including physical, occupational, speech therapies), hospitalization, and outpatient or ambulatory care.
Read through your plan to determine and make any necessary changes to ensure proper coverage in all of these areas for your employees.
Plan Design Changes
Plans shift frequently, and insurance providers will constantly be making changes, no matter how slight.. It’s important not to assume the plans you’ve chosen in the past have remained the same. Talk with your Providers closely to determine any changes to plan design and inform you employees of these changes.
As an employee, it’s important to remember that some services can make premiums change drastically, therefore it is important to review the plan itself, to avoid getting charged more unexpectedly.
FSA and HSA Benefits
Negotiating FSA and HSA benefits can be difficult when sorting out plan details for your insurance plan offerings. Some organizations choose to opt-out of FAS or HSA benefits due to the added expense. As an employer, it can be helpful to take a poll from your employees—especially in a small company—to determine the need or desire for FSA and HSA plans. If this is done early enough, you can add or remove these from your plan details.
Make sure you share any details regarding COBRA with your employees. If they leave the company during the next year after open enrollment, they will have COBRA as an option for coverage. More information on COBRA can be found here.
Wellness Plan Offerings
Another factor to consider is if you would like to offer wellness plans to your employees. Wellness plans can be everything from offering reimbursements for gym memberships to purchasing healthy food options for the office. Wellness plans can be a major incentive for employee retention and help promote a healthy environment both in and outside of work.
Determine FT and PT Employees
Getting an accurate headcount for your full and part-time employees can help determine what plans to offer and the potential cost of premiums. Federal law does not require employers to offer coverage to part-time employees, so it’s important to communicate to the proper individuals on coverage needs.
Deadlines and Reporting Procedures
Know your deadlines with 100% certainty. Share the deadlines early and frequently with your team. Tell them how they will be alerted (email, text, meetings, etc.) and keep them in the know.
Logins and Enrollment Portal Set-Up
Lastly, ensure every employee receives a login and the link to access your benefits enrollment portal. This is critical even if they are choosing to opt-out of insurance. Any employee choosing to forego a health plan through their employer must indicate that via the enrollment portal. Those who wish to enroll in employer-provided health benefits must log in and access the information, preferably before the window begins. You don’t want to have to deal with employees not being able to access their enrollment portal during the height of the busy enrollment season.
This is just a small list of things to help you prepare for open enrollment. Building out a proper benefits compliance checklist can keep things in order, hold your team accountable, and ensure your employees get must-know information in a timely manner.
BeneQuick is a benefits enrollment portal that works with you and for you to ensure the best possible open enrollment for your organization. For more information or to get a FREE demo, contact us here.