Even before Supreme Court Ruling on Health Care Reform, DOL begins Auditing Plans

Though President Obama’s health care reform law, which went into effect in 2012, won’t receive a Supreme Court ruling regarding its constitutionality until June, the Department of Labor has begun auditing healthcare plans for compliance. Should the law be struck down by the nation’s highest court, the federal government still fully intends to punish violators of the law while it is in effect. In other words, those businesses holding off on compliance until the ruling this summer should reconsider their strategy and work to ensure compliance with all federal laws.

Regarding compliance, the DOL is looking for a few specific items from employers. In the case of grandfathered health plans, the DOL expects a statement making clear
the reasoning behind the decision to grandfather the plan under the new reform law and provide records that show the state of the plan as of March 23, 2010. However, only a minority of health plans will fall under this definition.

For non-grandfathered plans, each portion of the policy must have been in compliance with the new law from the moment the plan went into effect. The DOL will expect to see all documents related to preventative services for each year, the plans
claims and appeals procedure, first and final notices of adverse benefit determinations, and contracts with third-party administrators that provide external plan reviews.

There are also provisions that must be complied by both types of plans. As such, all plans must additionally show a sample notice describing opportunities for enrollment for dependents aged 26 and under, a list of plan participants with rescinded coverage and the
reason(s) for the cancellation, and any documents involving annual or lifetime limits on the plan.