Auditing Eligibility After Health Care Reform
Health Plan Compliance Issues (Including Health FSAs and HRAs)
Auditing health plan eligibility can create significant cost savings and improve general enrollment and administrative processes. Whether or not a formal, standalone audit is involved, significant compliance issues must be considered, including important impacts under health care reform. In this 90-minute web seminar, our experts will help plan sponsors, service providers, and advisors evaluate the pros and cons of audits, understand the logistics and legal issues, and plan effective eligibility audits for employer health plans.
Originally presented on November 10, 2011.
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Here’s some of what was covered:
- What impact does health care reform’s age 26 mandate have for eligibility audits?
- How does health care reform’s prohibition on rescission affect eligibility audits? What plan language may help preserve the ability to retroactively terminate ineligible individuals?
- How should eligibility rules be explained to employees? Should health FSAs and HRAs require affirmative enrollment of family members?
- What are the mechanics of a typical eligibility audit? How should an audit be communicated to employees, and should an amnesty period be provided?
- Who should be audited, and what special compliance issues are presented when auditing particular groups (e.g., children and domestic partners)? What proof should employees be required to submit regarding dependent eligibility?
- What other legal issues might arise from an eligibility audit (e.g., must COBRA be offered to ineligibles dropped from coverage)?
Speakers: Darcy L. Hitesman and Deirdre C. Thomas. Ms. Hitesman is an attorney and principal shareholder of Hitesman & Associates, P.A., in Minneapolis. She is a Contributing Author of EBIA’s ERISA Compliance for Health & Welfare Plans manual. Ms. Thomas is an attorney and Senior Editor at EBIA, and a Contributing Author and Editor of EBIA’s ERISA Compliance for Health & Welfare Plans manual.
Handouts: A handout of the seminar slides and other information is provided through download.
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