Written By: Derek Winn
If you rely on your health plan, and cannot afford to lose your plan and be non-renewed for failing an audit, here are some helpful tips to make sure you are compliant, and can pass any audit with ease.
Carriers are ramping up their audit of clients to ensure several items:
- All enrolled members are legitimate Employees of a group
- A group is meeting the 75% participation requirement
- Employers are playing by the rules when it comes to contributions.
There are several steps all Employers should be doing in the event that they receive an audit request in the mail:
- Call your consultant as soon as the audit is received – Your consultant is your ally and advocate. They can help overcome an audit with success by working diligently with you to ensure that all required areas are complete.
- Keep all waivers on file – It’s important that your total pool of Eligible Employees is reduced for every eligible waiver. The “good” waivers are waivers due to other group coverage, such as a Spouse’s Employer Sponsored plan, TRICARE, Medicare, etc.
- Wage and Tax Review – If an Employee isn’t on your wage and tax, they shouldn’t be on your invoice (unless they’re a new hire, or on State Continuation/COBRA).
- Be sure to respond in a timely manner – The greatest risk with a failed, or even an audit that is not returned is that a carrier will non-renew your group. This means that in order to retain coverage at renewal, you are looked at as a brand new group, meaning that you have to re-start the entire new case submission process.
- Establish objectives for your next renewal – If you follow these steps to prepare for an audit, and start to sweat about potentially getting one in the near future, that means we have work to do at your next renewal.
Here are some ways to help ensure that your next renewal leaves you in a better position for an audit:
- Offer more than one plan option. Most carriers today will allow for up to three health plans in the under 25 market, and usually four plans over 50 Employees. At 100 Employees, you can even lobby to have more than one carrier. There is no “one size fits all” solution, so offer multiple options to your Employees to give them what they need or want.
- Re-work plan funding, and consider a SUPER low cost plan alternative. The number one decision making factor for Employers regarding plan selection is cost – this is also the same for Employees.
- This can also help to get your contributions in-line by fulfilling the minimum contribution requirement.
- Work to better educate your Employees on the risks they run without health insurance, and how your Employer sponsored plans work. This will not only get their attention, but with a low cost plan option, may push them toward participating.
It is important to keep in mind that part of Health Care Reform is the mandate that Americans be covered under a plan – staying ahead of the curve, and being prepared for an audit is good practice for 2014.
BBG is here to help with carrier audits to help your group remain compliant, and also retain coverage when faced with potentially being non-renewed.