The Department of Labor’s Employee Benefits Security Administration (EBSA) has published online two tools to enable group health plans, plan sponsors, plan administrators and health insurance issuers comply with the group health plan requirements (Part 7) of ERISA.
The first guidance document, Self-Compliance Tool for Part 7 of ERISA: HIPAA and Other Health Care-Related Provisions, is a detailed checklist with questions to help educate those involved in operating a group health plan to understand the laws and their related responsibilities under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Mental Health Parity Act, the Mental Health Parity and Addiction Equity Act, Michelle’s Law and other health care-related laws. The compliance tool provides an informal explanation of applicable statutes and other regulatory/administrative interpretation materials, but is intended as general guidance, “and should not be considered legal advice or a substitute for any regulations or interpretive guidance issued by EBSA.”
The second document, Self-Compliance Tool for Part 7 of ERISA: Affordable Care Act Provisions, similarly provides a detailed question and answer checklist addressing the various Affordable Care Act (ACA) provisions applicable to group health plans and health insurance issuers. Various sets of questions allow users to assess their plan’s compliance with ACA provisions addressing grandfather plan status; extension of dependent coverage to adult children; prohibitions on lifetime limits and restrictions on annual limits; prohibition on preexisting condition exclusions for individuals under 19; summary of benefits and coverage (SBC) and uniform glossary; coverage of preventive services; and internal claims and appeals and external review.