Why Compliance Matters in Group Plans
Maintaining legal compliance in your group benefits plan isn’t just a matter of paperwork—it’s essential for protecting both your business and your employees. Failure to comply with applicable regulations can result in significant financial penalties, legal disputes, and erosion of trust among your workforce. Compliance ensures that employees receive fair and lawful access to benefits while shielding employers from costly enforcement actions.
Many regulations are designed to promote transparency, protect sensitive health information, and ensure employees understand their rights. By staying compliant, employers not only meet legal standards but also support a more organized and equitable workplace.
What ERISA, ACA, and HIPAA Require
Several major federal laws govern group benefits. Understanding the basics of each can help employers meet their obligations:
- ERISA (Employee Retirement Income Security Act): Requires employers to provide Summary Plan Descriptions (SPDs), ensure fiduciary responsibility in managing plans, and file annual Form 5500 reports for certain plans.
- ACA (Affordable Care Act): Mandates minimum essential coverage for applicable large employers (ALEs), limits waiting periods, and prohibits annual or lifetime coverage limits on essential health benefits.
- HIPAA (Health Insurance Portability and Accountability Act): Protects the privacy and security of employee health information and establishes rules for the use and disclosure of personal health data.
Failing to meet even one of these obligations can result in significant fines. For instance, failing to provide an SPD under ERISA can result in a cost of up to $110 per day per employee.
Where Employers Often Slip Up
Even well-meaning employers can make mistakes. Some of the most frequent compliance errors include:
- Missed or outdated disclosures: Not providing SPDs or notices about COBRA rights, HIPAA privacy practices, or ACA marketplace options.
- Employee misclassification: Incorrectly classifying workers as independent contractors can lead to benefits violations and back penalties.
- Inadequate documentation: Lack of proper documentation on eligibility, elections, or plan amendments can hinder audits and open the door to legal challenges.
Real-world example: A small business failed to update its COBRA notices in line with federal guidance. When a former employee filed a lawsuit, the company faced legal fees and settlement costs exceeding $20,000.
Audits, Updates & Oversight
Staying compliant requires ongoing attention. Conduct an annual review of your group benefits plan to ensure documents, procedures, and communications are up to date. Monitor changes in state and federal law, particularly during open enrollment and budgeting periods.
Many businesses partner with third-party administrators (TPAs) or insurance brokers who specialize in benefits compliance. These experts can help manage the documentation and file required forms and ensure your plan design meets legal standards.
The Compliance Checklist
- Provide and regularly update Summary Plan Descriptions (SPDs)
- Confirm ACA reporting requirements (Forms 1094/1095) are met
- Maintain secure storage for employee health information per HIPAA
- Issue COBRA, CHIPRA, and HIPAA notices as required
- Properly classify employees and verify eligibility
- Conduct annual plan reviews and compliance training
Secure Your Benefits—and Your Peace of Mind
We help businesses stay compliant and confident in their group benefits programs. Whether you’re just starting or revisiting your current plan, our experts at Republic Associates of WI can guide you through the legal requirements and best practices to ensure your benefits are working for you and your team.