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Employee Benefits Compliance: A Business’s Checklist

Employee Benefits Compliance A Business’s ChecklistToday’s environment requires keeping abreast of state and federal employee benefits regulations and maintaining compliance. This can be quite time-consuming and, if not done properly, can result in a lawsuit for your business. Legislation such as HIPAA, COBRA, USERRA, the Medicare Modernization Act and the Affordable Care Act have many HR departments working tirelessly to secure the management of these plans. 

Affordable Care Act 

The ACA defined who was an applicable large employer (ALE) as those with at least 50 full-time employees. Any qualified ALE must provide coverage that meets the ACA’s affordability standard for all full-time employees. This standard requires an employee’s contributions to the plan to not exceed a designated percentage of the employee’s household income for the taxable year.

The ACA’s out-of-pocket maximum applies to all non-grandfathered group health plans, including self-insured health plans and insured plans. Non-grandfathered health plans must cover certain preventive health services without imposing cost-sharing requirements for services. Health plans have to adjust their first-dollar coverage of preventive care services based on the latest preventive care recommendations.

Non-grandfathered group health plans and issuers that require designation of a participating primary care provider must permit each participant, beneficiary, and enrollee to designate any available participating primary care provider (including a pediatrician for children).


The Consolidated Omnibus Budget Reconciliation Act (COBRA) applies to employers with 20 or more employees that sponsor group health plans. Plan administrators must provide an initial COBRA notice to new participants and certain dependents within 90 days after plan coverage begins. You may incorporate the initial COBRA notice into your plan.


A group health plan must provide each eligible employee with a notice of his or her special enrollment rights under HIPAA. You must provide the notice at, or prior to, the time of enrollment. 

The HIPAA Privacy Rule requires covered entities to provide a Notice of Privacy Practices to each individual who is the subject of protected health information.

Health plans must send these Privacy Notices at certain times, such as new enrollees at the time of enrollment and at least once every three years, health plans must either redistribute the Privacy Notice or notify participants the Privacy Notice is available and explain how to obtain a copy. Group health plans that offer a health-contingent wellness program must furnish a HIPAA wellness program notice. 


Group health plans covering residents in a state that provides a premium subsidy to low-income children and their families to help pay for employer-sponsored coverage must send an annual notice about the available assistance to all employees residing in that state.


Group health plan sponsors must provide a notice of creditable or non-creditable prescription drug coverage to Medicare Part D eligible individuals. These individuals include those who are covered by, or who apply for, prescription drug coverage under the health plan. This notice alerts individuals as to whether their prescription drug coverage is at least as good as Medicare Part D coverage. You must provide the notice at various times, including when an individual enrolls in the plan and each year before Oct. 15 (beginning of open enrollment.)  

Is compliance something that your business struggles with? We can help you by taking compliance out of your hands and into ours. Contact us today for more information on our compliance program.

About AJ Benet Insurance Agency

At AJ Benet Inc. Insurance Agency, we make sure that your New York Business Insurance policy includes more than the simple general liability and product liability. Our policies extend in cases where your underlying limits are exhausted. Our team of experts is willing to go the extra mile and not only protect your business but understand it. For more information, call us today at (914) 381-2040.

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