In recent months, the Department of Labor (DOL) has increased enforcement activity related to the Affordable Care Act (the ACA), commonly known as “Health Care Reform.” Plan sponsors of group medical plans should be prepared for DOL audits aimed at determining compliance with the ACA. This client update outlines the information and supporting documentation that plan sponsors should maintain.
The DOL is particularly focused on “grandfathered” plans, which are not required to implement all of the ACA’s market reforms. To preserve “grandfathered” status, a plan must not have significantly altered costs and levels of coverage since the ACA’s initial implementation date (September 23, 2010). Plans purporting to maintain grandfathered status should retain the following documentation:
For all plans, regardless of grandfathered status, the DOL is focused on compliance with the ACA’s market reforms (i.e. limitations on rescissions of coverage and waiting periods, offer of contraception coverage). Plans should maintain, at a minimum, the following documentation:
In addition to ACA-mandated compliance measures, the DOL has been asking for proof of compliance with ERISA and HIPAA. Therefore, plan sponsors should be prepared to present the following documentation:
Given the uptick in enforcement activity and the limited amount of time that the DOL allows to respond, plan sponsors should have all of this information readily available.