DOL Offers Health Plan Self-Compliance Tools

March 15, 2013 ( – The Department of Labor (DOL) has issued checklists to help with determining if group health plans comply with regulations.

In the checklist for Affordable Care Act (ACA) provisions under Part 7 of the Employee Retirement Income Security Act (ERISA), the agency address a health plan’s status as a “grandfathered” plan exempt from some ACA requirements, limitations on rescission and annual and lifetime limits and the new Summary of Benefits and Coverage.  

The checklist for HIPAA and other health-care provisions of Part 7 of ERISA addresses rules under the Health Insurance Portability and Accountability Act (HIPAA), preexisting conditions exclusions, certificates of creditable coverage, special enrollment rights, wellness programs and mental health parity.   

The DOL explains that while the self-compliance tools do not necessarily cover all the specifics of these laws, it is intended to assist those involved in operating a group health plan understand the laws and related responsibilities. It provides an informal explanation of the statutes and the most-recent regulations and interpretations, as well as including citations to the underlying legal provisions. The information is presented as general guidance.  

In addition, some of the provisions discussed involve issues for which the rules have not yet been finalized. Proposed rules, interim final rules, and transition periods generally are noted.