What to Know About Employee Benefits Compliance

Posted on: January 6, 2020 by iSure

When administering an employee benefits program, compliance should be a priority. Compliance is about more than simply avoiding penalties. Running a compliant business ensures you’re offering employees a minimum acceptable level of benefits. It’s critical your business remains compliant at all times. This compliance ensures the safety and security of both your organization and its employees.

This is a broad, complex topic that will require thorough employee benefits solutions and a well-versed agent to get down to the nitty-gritty. 

Grandfathered Plan Status

A grandfathered plan is one that was in existence when the Affordable Care Act (ACA) was enacted in 2010. Certain changes to your plans that go beyond permitted guidelines, can remove grandfathered status. If you have a grandfathered plan, determine whether it will maintain its grandfathered status for the year. If your plan will maintain its grandfathered status, make sure you provide the notice of grandfathered status in your open enrollment materials. In the event that your plan loses its grandfathered status, confirm the plan has all the additional patient rights and benefits required by the ACA. 

Affordable Care Act 

The ACA defined who was an applicable large employer (ALE). 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 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 the services. Health plans have to adjust their first-dollar coverage of preventive care services based on the latest preventive care recommendations.


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. Also, you may include this notice in the plan’s SPD.

The HIPAA Privacy Rule requires covered entities (including group health plans and issuers) to provide a Notice of Privacy Practices (or Privacy Notice) to each individual who’s the subject of protected health information (PHI). Health plans must send these Privacy Notices at the time of enrollment. 


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.

Plans and issuers must provide notice of participants’ rights to mastectomy-related benefits. This notice is required under the Women’s Health and Cancer Rights Act. Plan issuers need to include this notice at the time of enrollment and on an annual basis.

Plan administrators must include a statement within the Summary Plan Description timeframe describing requirements relating to any hospital length of stay in connection with childbirth for a mother or a newborn child under the Newborns’ and Mothers’ Health Protection Act. Speak to an agent to discuss what employees’ benefits solutions are best for your business. 

About iSure Insurance Brokers

After serving leaders in the Greater Miami market for more than three decades, iSure Insurance Brokers has become the provider of choice for discerning commercial clients and individuals alike. Because no two insurance programs are or should be alike, you can be sure that iSure will craft a comprehensive approach to protection that is as unique as you are. We welcome the opportunity to protect what you have worked so hard to build. Please contact us at (305) 223-2533 to learn more about what we can offer you.

Posted in: Blog Employee Benefits