TPA Helps Employers Understand Common Documentation Requirements as the Number of DOL Health Plan Audits Increases

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With the recent implementation of Affordable Care Act and other requirements, the Department of Labor (DOL) has increased the number of health plan audits at U.S. businesses. Cypress Benefit Administrators serves as a resource in offering compliance assistance and helps employers better prepare for these regulatory assessments with information on common documents reviewed.

Cypress Benefit Administrators
Even though every audit conducted by the DOL is totally unique, employers can still be proactive about the process by ensuring they have the standard documentation in place.

As the number of Department of Labor (DOL) health plan audits continues to increase in 2014, Cypress Benefit Administrators – a third party administrator (TPA) with locations across the United States – offers a summary of some of the documents commonly reviewed to help employers better prepare.

In completing audits, the DOL and its Employee Benefits Security Administration (EBSA) division will often request materials related to how the plan works, including Summary Plan Documents (SPDs) and Plan Documents, along with any amendments made.

Other key areas include:

  • Administrative Recordkeeping – paperwork that includes everything from billing invoices and records of payroll deductions to unresolved medical claims
  • Affordable Care Act – documents ranging from Summary of Benefits and Coverage (SBC) and Health Insurance Exchange Notices to specific documents for grandfathered and non-grandfathered plans
  • HIPAA – documents ranging from plan eligibility rules and sample Certificates of Creditable Coverage to written appeal procedures and Notice of Privacy Practices

Additionally, the DOL will often request to review materials that fall under other health-related laws such as COBRA, the Newborns’ Act Notice and the Women’s Health and Cancer Rights Act.

According to Tom Doney, president and CEO of Cypress Benefit Administrators, every company with an ERISA-covered plan is subject to a DOL health plan audit.

“There’s a common misconception out there that only larger companies get audited by the DOL,” Doney said. “That’s not the case. With new requirements in place under the Affordable Care Act, we’ve seen a lot more audits happening at companies of every size.”

A company is typically notified in writing if it has been selected for an audit, but there are certain circumstances where no advance notification is given.

“Even though every audit conducted by the DOL is totally unique, employers can still be proactive about the process by ensuring they have the standard documentation in place,” Doney said.

Depending on the items cited in the DOL’s Final Audit Report, employers can face punitive actions ranging from civil penalties of varying fees to criminal provisions for more serious violations.

In addition to locating the necessary documents, Cypress recommends that employers file them in a binder that is indexed and organized by year. This is dual-purpose in that it helps companies prepare for audits and stay in compliance with ERISA-required notices.

A privately held company headquartered in Appleton, Wis., Cypress Benefit Administrators has been pioneering the way toward cost containment in self-funded health benefits since 2000. The third party administrator (TPA) is the country’s first to bring claims administration, consumer driven health plans and proven cost control measures together into one package for companies ranging from 50 employees to thousands of employees. It serves employer-clients across the U.S. with additional locations in Portland and Salem, Ore., Omaha, Neb. and Colorado Springs, Col. For more information on Cypress and its customized employee benefits, visit

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Lori Van Handel
Willems Marketing
+1 (920) 750-5020
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Tom Doney
Cypress Benefit Administrators
(920) 968-4613
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