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Benefits Compliance: Finding Opportunity in Obligation

Benefits Compliance: Finding Opportunity in Obligation
Posted on Friday, April 23, 2021 by Bruce Gillis

Adhering to the many benefits-related regulations is more than a set of legal obligations; it presents HR professionals with an opportunity to protect those we serve.


Whether you’re an HR generalist, a CHRO, or a benefits administrator, you’re already keenly aware that the people you serve—your employees—rely on you for a lot more than ensuring they get paid on time. The benefits your team provides ensure that your employees and their covered dependents feel safe, secure and protected every day, whether on or off the clock.

And when it comes to benefits compliance, it’s all about ensuring you’re doing your job right for all the right reasons.

Start by taking inventory

While protecting the rights and privacy of employees and members in your benefits system is a shared responsibility across your organization and your vendors, HR/benefits professionals fill a special role in ensuring compliance. It all starts with knowing how to navigate the rapidly changing landscape of health and welfare regulations at the state and federal levels.

That’s why we developed the Businessolver Compliance Inventory. Updated three to four times per year, this guide helps HR professionals navigate nearly 100 state and federal compliance issues, including easy-to-follow instructions for sending required notices to plan participants.

While the primary audience for this resource is benefits administrators, the real winners are the employees they serve. By helping HR professionals understand their responsibilities under a myriad of quickly evolving regulations, their employees’ rights are preserved and their privacy protected.

Find opportunity in obligation

Benefits professionals are well-versed in compliance issues and often regard them as obligations that yield few, if any, opportunities to improve benefits’ cost-effectiveness or overall benefits strategy. Failing to comply with COBRA notice requirements, for example, can result in a fine or an excise tax of $100 per person per day per violation.

Occasionally, though, a regulation comes along for which the potential opportunities far outweigh the burden of the obligation. A good example is the Transparency in Coverage Rule. Finalized in late 2020, the rule seeks to allow Americans to more accurately predict their healthcare costs by helping them find and filter care providers within their network and location, and with respect to the amounts paid toward their deductible and out-of-pocket maximum

With effective dates staggered across a three-year period, the new regulation methodically peels back the curtain that has obscured the personal and macro-economics of healthcare for decades. And for benefits professionals, there’s never been a better opportunity to increase employees’ engagement in their healthcare and pharmacy benefits.

For plan years beginning on or after:

Jan. 1, 2022 Jan. 1, 2023 Jan. 1, 2024
Publicly disclose:

  • Negotiated rates for in-network providers
  • Historical allowed amounts for out-of-network providers
  • Prescription drug costs 
Disclose to participants via online self-service tool:

Disclose to participants via an online self-service tool:

  • All covered healthcare items and services 


Empowering employees with resources like these not only helps them make more informed decisions, it also provides employers with the opportunity to save on their healthcare and pharmacy costs.

Don’t get caught by surprise

Another example of a compliance issue having a positive impact on employees and employers alike is the No Surprises Act. Signed into law in late 2020, this long-awaited regulation protects patients from previously unforeseeable or unavoidably high medical costs.

Intrinsically connected to the Transparency in Coverage Rule, the No Surprises Act has been a high-priority and bipartisan issue for decades. It is intended to address three scenarios where a participant receives a large medical bill through no fault of their own:

  1. A plan participant has an emergency medical condition that lands them in an out-of-network hospital or emergency room. Because it’s out-of-network, they receive a balance bill.
  2. A participant schedules a procedure at an in-network facility but, without knowledge or consent, receives treatment from an out-of-network provider (e.g., an anesthesiologist) . As above, they receive a balance bill.
  3. A participant is transported by an air ambulance service provider, often following a car crash or other emergency that renders them unconscious. Unfortunately, very few of these providers have negotiated with even the largest insurers, resulting in out-of-network bills of more than $40,000 per ambulance ride.

By not holding plan participants liable under these scenarios, employees—and employers in most cases—are protected from unforeseeable or unavoidable medical costs.

How big a deal is this? Simply put, pretty big. Consider these statistics:

  • 44% of Americans have received a surprise out-of-network bill.
  • Among those, 68% said the bill was difficult to pay.
  • 11% said they could not pay the bill at all.

Ready to learn more about serving your employees while staying compliant? Check out our new page, Benefits Compliance is Everyone’s Job.


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Bruce Gillis Head of Compliance Lorem ipsum dolor sit amet. View All Posts