July 17, 2012

ACA Compliance Audits

Not only is it HIPAA privacy compliance that is being reviewed by the government, but the DOL is making efforts to ensure that health plans comply with the HIPAA portability segment of the law as well.  The DOL doesn’t stop there – they are including, in their audits, a review to ensure a plan is compliant with the Affordable Care Act provisions that are in effect.  Among these are the requirement to allow dependent children to remain on their parent’s plan until age 26, the requirement to impose no preexisting condition exclusion on a child under age 19, the requirement to impose no lifetime limits on essential benefits, implementation of an internal claims, appeals and external review process, as well as substantiation and disclosure requirements relating to grandfathered health plan status.  Clearly it the intent of the government agencies that plans comply with applicable rules.


The information contained in this Benefit Beat is not intended to be legal, accounting, or other professional advice, nor are these comments directed to specific situations.

As required by U.S. Treasury rules, we inform you that, unless expressly stated otherwise, any U.S. federal tax advice contained in this Benefit Beat is not intended or written to be used, and cannot be used, by any person for the purpose of avoiding any penalties that may be imposed by the Internal Revenue Service.

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