The health insurance industry has changed dramatically over the past decade due to the Affordable Care Act (ACA). Compliance audits are on the rise, and the industry has become incredibly compliance-focused. While this brings new challenges to many, it also creates new opportunities for you in your service to prospects and clients.
Today, more than ever before, employers are looking for help when it comes to ACA and related employee benefits compliance. That means, as a Word & Brown broker, you can use our full range of in-house compliance services – backed by the WBCompliance team – as a prospecting and retention tool when talking with employers. (Keep in mind, though, that the information we share does not constitute legal advice. Your clients should always seek professional counsel as it relates to tax and legal matters.)
Compliance Conversation Generator (CCG)
Our exclusive CCG is a practical guide to help you get compliance discussions started with employers. It will demonstrate to your prospects and clients your value as a health insurance broker and assist you in generating new business opportunities.
It contains compliance-centric questions you can reference and ask your customers. Behind those questions, you will discover information you can use to supplement your conversations around each of the CCG topics. You will sound like an expert and your prospects and clients will look to you as their go-to resource in the future.
The CCG breaks compliance into simple-to-understand topics; it includes the following talking points:
- ACA
- ERISA
- COBRA
- Account-Based Plans
The ACA portion of the guide includes information on:
- Small Group member level rates
- Full Time (FT) and Full Time Equivalent (FTE) employees
- Hours of service
- Group size and market segment
- Group size and Applicable Large Employer (ALE) status
- Commonly owned companies
- ACA ALE employer mandate
- ACA reporting responsibilities
- ACA noncompliance penalties
- Documentation for employees
- Out-of-pocket maximums and Essential Health Benefits (EHBs)
- Annual Special Open Enrollment Window (SEOW)
The ERISA portion of the CCG includes guidance on:
- Definition of ERISA
- Employers subject to ERISA
- ERISA compliance
- Benefit plans subject to ERISA
- ERISA plan documents
- Summary Plan Description (SPD) documents
- Delivery of SPDs to plan participants
- Definition of “participants” under ERISA
- Noncompliance penalties
The COBRA CCG addresses these topics:
- Federal COBRA
- State COBRA
- Federal COBRA administration
- Controlled Groups and Common Ownership
- COBRA notices and distribution methods
- Qualifying events
- Open enrollment
The CCG also includes information on Account-Based Plans:
- Section 125 Premium Only Plans (POPs)
- Flexible Spending Accounts (FSAs)
- FSA Grace Period or Carryover Provision
- Limited Purpose Health FSAs
- IRS nondiscrimination testing
While the CCG is not intended as a leave-behind for prospects and clients, you’ll find it useful in your compliance-related conversations with both.
ACA Compliance Checklist
Another useful tool developed by Word & Brown is the ACA Compliance Checklist, which was recently updated for 2019.
The Checklist provides a summary of the general tasks associated with ACA compliance. While not all of the information included will apply to each of your clients, it’s a great snapshot of things your clients should consider to ensure they fully comply with their ACA responsibilities, including:
- Budget considerations (group size, ALE, common ownership, and more)
- Health plan administration (waiting periods, orientation period, FSAs, 1099 employees, etc.)
- Employee documents (DOL notice, SBC, Uniform Glossary, modification notice, et. al.)
Put Our Team to Work for You
Word & Brown’s WBCompliance team – and everyone at Word & Brown – is committed to your success. We want to help you continue to grow your business in today’s changing health insurance environment. Contact your Word & Brown representative or the nearest Word & Brown office to learn more about all of our available resources – or download the Compliance Conversation Generator.
