Auditing Eligibility After Health Care Reform

Health Plan Compliance Issues (Including Health FSAs and HRAs)

For one registration fee ($279), you and your co-workers can gather in one room to attend the web seminar together via a single web connection.

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.

Seminar Level

Intermediate Difficulty

Topics Covered

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.

Viewing Details

  • Accessing the recorded web seminar: After you purchase a recorded web seminar, you will receive an email with access information. You and your co-workers (not clients or others, please) may then view the recording as many times as you wish for 60 days. An Internet connection is required to view the recording; it can be stopped and started as needed and has a table of contents for easy navigation.
  • Recordings are accurate as of the date presented: Our recordings are accurate as of the presentation date of the live seminar. We supplement handout materials with articles from the EBIA Weekly covering significant later developments. You must check the table of contents at your access link for updates before viewing a recorded seminar.
  • Please respect our copyright: Do not record the web seminar. Share the access link and materials only with those employed by your company (not clients or others, please). For details on our copyright policy, please visit our Copyright page.

System Requirements for Recorded Web Seminars

EBIA uses WebEx technology for the seminar.

EBIA Weekly

Keep up on all the latest developments with our
FREE email newsletter.

Sign up for EBIA Weekly!

Weekly Archives »

Web Seminars

View all »

Search help »

News and Information

View all »