Healthcare compliance isn’t just a legal obligation — it’s a fiduciary responsibility. Employers who stay ahead of their compliance requirements protect their organizations from penalties, litigation, and reputational damage. This guide gives you the practical framework to do it right.
The Most Common Compliance Failures We See
- Plan documents that haven’t been updated since the ACA passed
- SPDs distributed late or not at all to new enrollees
- COBRA election notices sent after the 14-day deadline
- No Section 125 POP plan in place — leaving payroll tax savings on the table
- Form 5500 filings missed or filed late for large plans
- ACA 1094-C/1095-C reporting errors or missed deadlines
- HIPAA Business Associate Agreements missing with key vendors
Building a Compliance Calendar
Compliance is a year-round responsibility, not an annual event. Remedy Advisors helps clients build a benefits compliance calendar that maps every deadline — COBRA notices, open enrollment, 5500 filings, ACA reporting, plan document reviews — so nothing falls through the cracks.
Self-Funded Compliance: Additional Considerations
- ERISA fiduciary responsibility is heightened for self-funded plan sponsors
- Stop-loss contracts must be reviewed for compliance with state regulations
- TPAs must have current BAAs and be held accountable for their obligations
- Claims data handling must comply with HIPAA privacy and security rules
- Mental Health Parity and Addiction Equity Act (MHPAEA) compliance is increasingly enforced
Compliance as Risk Management
DOL audits are increasing. ERISA litigation is rising. The cost of non-compliance — in penalties, legal fees, and settlement exposure — far exceeds the cost of getting it right proactively. Remedy Advisors keeps our clients compliant so they can focus on their business.