Are Your Healthcare Benefits in Compliance?

Are Your Healthcare Benefits in Compliance?

Sometimes it seems like keeping your healthcare benefits in compliance is a long slog through a never-ending labyrinth of laws and regulations. Digitization has made it easier, but it can still be a pain to keep abreast of all the requirements, which, by the way, are at every governmental level. But keep up you must — or face big penalties as well as a hit to your reputation.

What about your organization? Are your healthcare benefits in compliance? Here’s what you should know.

The Issue

You want to give your people the best benefits possible, and they want you to provide them. But it’s mighty difficult keeping track of all the compliance rules and laws regarding, for example, COBRA, HIPAA, ERISA, and the Affordable Care Act (ACA), especially with a workforce that’s increasingly diverse and remote. And that’s not counting new legislation and modifications, and those coming down the pike.

Not keeping track or complying, however, can carry a steep price. For the ACA alone, cumulative employer penalties over the next decade are expected to reach a whopping $207 billion.

What Can I Do to Remain in Compliance?

Thanks largely to healthcare reform and heightened scrutiny, tracking and managing all the requirements can literally be a full-time job. After all, the days of voluntary compliance are over. Organizations must not only put a plan in place but be able to show implementation.

You would likely benefit from having outside help in fulfilling your compliance responsibilities while improving internal workflow processes, which frees you to focus on your core business.

More on external help later.

How Important is Communication?

There are times when organizations do work to comply but have no documents to show to someone outside the company. That’s why you need a compliance manual and a robust database for deadlines and documents so that you’re ready when called upon. And you will eventually have to provide documentation.

Once the data is pulled together, there should be a system in place for swiftly addressing compliance issues or concerns. You want to be able to promptly and thoroughly investigate possible misconduct so that remediation can occur that ensures future compliance.

Don’t You Want a Culture of Accountability?

Demonstrating a commitment to compliance adherence signals to employees and peers a devotion to excellence in performance as well as accountability. Such demonstration can go a long way toward fomenting a productive workplace culture.

Can Mercer Help?

The consultant has certainly helped scores of other organizations. After all, it specializes in healthcare compliance. Specifically, Mercer can:

  • Keep you apprised of new federal and state legislation and regulations — and deliver expert analysis.
  • Put together draft plan documents so that you’ll have them ready should someone outside the organization request them. We’ve already discussed possible compliance penalties and reputational damage resulting from not either unawareness or not being able to show compliance.
  • Help with complex health benefits such as domestic partnerships, retiree plans, and wellness programs, which do require compliance as well as tax considerations.
  • Provide a gap analysis. A compliance review can reveal where additional action is necessary regarding ERISA and HIPAA requirements.

Ultimately, making sure your healthcare benefits are complying with governmental rules and regulations takes deliberate action. What with potential penalties and reputational effects, this is not an area you want to drag your feet in. If you require outside assistance – and you most likely do – you should enlist the help of Mercer, which offers a blending of regulatory and legal expertise, expansive benefits knowledge, and formidable risk management capability.


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