Abbreviated Summary of Oswald’s Risk Assessment and Compliance Toolkit for Group Health Plans
Welcome!

This questionnaire will generate an approximate compliance percentage based on a snapshot of Oswald’s Compliance and Risk Assessment Toolkit for Group Health plans. Once this survey is complete, a team member from Oswald will contact you to review the outcome and discuss action steps towards compliance. By partnering with the Oswald Companies, employers reach 100% compliance with our ease-of-use materials, hands-on assistance and ongoing compliance maintenance (Oswald’s Risk Assessment & Compliance Toolkit).
 

Scale Point Values

  • 100% - In Great Shape!
    • Confident of our compliance and have procedures in place for ensuring ongoing compliance and recordkeeping.
  • 90% to 99% - In Good Shape!
    • Confident of our compliance and have resources to maintain compliance.
  • 60% to 89% - Action Steps Needed!
    • Compliant, but have not taken additional steps to ensure ongoing recordkeeping and compliance. We need support in this area.
  • 50% to 59% - Compliance Assistance Needed!
    • Unsure of compliance and considering options for additional support.
  • 20% to 49% - Compliance Assistance Needed!
    • Represents a concern for our organization, yet not informed or prepared to address without assistance
  • Below 20% - Not Compliant!
    • Represents a concern for our organization at multiple levels of management, and we are in need of compliance direction as soon as possible.

Tips and Hints
Not sure what a question is referring to?  Look for the yellow highlighted text to provide additional details.
Disclaimer: This annual federal compliance checklist for Group Health Plans (GHPs), Oswald's Compliance and Risk Assessment Toolkit, including this online abbreviated online survey, summarizes the reporting and disclosure responsibilities required under the Employee Retirement Security Act of 1974 (ERISA) and the Affordable Care Act (ACA). The Internal Revenue Service (IRS) and the Department of Health and Human Services (HHS) regulatory requirements are subject to change. Materials are solely for informational purposes. Please contact legal counsel to obtain advice with respect to any specific issue.
 
 
 

Getting Started
To help us better understand your business and your compliance needs, please answer the following:
 
Your Full Name*
 
 
Email*
 
 
Your Phone Number
 
 
Your Organization's Name*
 
 
Number of Insurable Lives?*
 
 
What industry are you in?*
 
Agribusiness/Natural Resources/Mining/Utilities
Arts/Entertainment
Associations/Membership Organizations
Construction/Architecture
Education – Colleges, Universities, Professional
Education - Elementary and Secondary Schools
Education – Vocational
Finance/Insurance
Health and Aging
Life Sciences
Manufacturing
Private Equity
Real Estate
Retail
Services - Food
Services - General
Services - Government/Civil
Services - Health
Services - Legal
Transportation
Other
 
How did you hear about Oswald?
 
 
 
 
 
 

Open Enrollment Communication Review 

How confident are you that your organization is compliant with notice requirements listed below?

 
Women’s Health and Cancer Rights Act (WHCRA)?*
 
 
 
 
Newborns’ and Mothers’ Health Protection Act (NMHPA)?*
 
 
 
 
Mental Health Parity and Addiction Equity Act (MHPAEA)?*
 
 
 
 
Qualified Medical Child Support Order (QMCSO)?*
 
 
 
 

Discussion Items to Review
 
How confident are you that electronic communications options are available to employees? (Note that electronic communication options are available if within the ERISA electronic communication safe harbors, i.e., intranet systems for employees with access to computers within their customary work duties)*
 
 
 
 
How confident are you that your organization has a recordkeeping process in place in the event of a DOL audit?*
 
 
 
 
How confident are you that your organization distributes the CHIP notice annually to all employees in qualifying states?*
 
 
 
 
Marketplace (Exchange) Notice
Effective 10.01.13. All employers subject to theFair Labor Standards Act (FLSA) must provide Marketplace (Exchange) Notice to employeesand ALL new hires within 14 days of hire. There are two model notices: If coverage is offered & ifcoverage is not offered. Notice must be delivered to all employees, regardless of plan eligibility. See Oswald’s template cover letter option to assist in explaining these forms to employees (and the reason for distribution).
 
How confident are you that your organization provided a Marketplace (Exchange) Notice to all employees, regardless of plan eligibility?*
 
 
 
 
How confident are you that your organization delivers the Exchange Notice to all new employees within 14 days of hire?*
 
 
 
 
 
 

Consolidated Omnibus Budget Reconciliation Act (COBRA)

If fewer than 20 full-time employees, COBRA is not applicable.
 
An initial COBRA notice must be provided to new plan participants as a notification of potential eligible qualifying events, as well as the requirement that a participant notifies the employer of a COBRA qualifying event. COBRA notices now include NEW options for COBRA Coverage Continuants as a result of the ACA.
 
How confident are you that the required notices are regularly sent to and from the TPA/ COBRA administrator within 90 days of initial enrollment and within 30 days of a qualifying event?*
 
 
 
 
 
 

Medicare Part D Notice to Eligible Participants & Reporting Requirements
An annual notice must be sent to Medicare Part D eligible individuals indicating whether the plan’s prescription drug coverage is Creditable or Non-Creditable. Plan sponsors must also disclose to CMS through the CMS website whether the plan’s prescription drug coverage is Creditable or Non-Creditable within 60 days of the beginning of the plan year (by March 1 for calendar year plans). Non-Creditable Coverage is RX coverage that is NOT expected to pay as much as standard Medicare.
 
How confident are you that your organization distributes the notice of Creditable or Non-creditable prescription drug coverage annually to eligible individuals (both employees & retirees eligible for Medicare) prior to October 14th?*
 
 
 
 
How confident are you that your organization has a process in place to annually report the RX coverage status on the CMS website?*
 
 
 
 
 
 

Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security Policy & Procedure Compliance (HITECH AMENDMENTS)
HIPAA requires Group Health Plans (GHPs) to establish written privacy and security policies and procedures for regarding Protected Health Information (PHI). In September 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act amended HIPAA, addressing technology, data and security safeguards.
 
Has a HIPAA privacy officer been established & documented for your organization?*
 
 
 
 
Has a HIPAA policy & procedure manual been documented & maintained for your organization?*
 
 
 
 
Have members of the covered entity’s workforce (i.e., plan sponsor’s workforce working with PHI) been formally trained?*
 
 
 
 
 
 

Summary Plan Description (SPD)

If a fully insured plan, the insurer will provide the SBC.
 
An SPD must be provided to participants & beneficiaries within 90 days of participation; within 120 days as a plan becomes subject to ERISA; every 5 years for an amended plan and 10 years for a non-amended plan.
 
How confident are you that new hires in your organization receive an SPD within 90 days of plan participation?*
 
 
 
 
How confident are you that Summary of Material Modification (SMM) have been added to the SPD/WRAP document as they relate to new legislation? Including but not limited to; COVID-19 Testing, Telemedicine and Expanded FSA, HSA & HRA Benefits
 
 
 
 
Is corporate counsel or a law firm resource accessible for specialized assistance in combining plan document?*
 
 
 
 
How confident are you that your organization has a process established to provide the uniform Summary of Benefits and Coverage (SBC) "Mini SPD" to participants and beneficiaries?*
 
 
 
 
 
 

Flexible Savings Account (FSA) Contribution Increase

Effective Plan Years after 01.01.20 - Contribution limit has increased from $2,700 to $2,750.
 
This is an optional plan amendment, and the amount which an employer may permit to rollover from a prior year is unaffected as the rules for administering FSAs are otherwise unchanged. No changes have been issued for daycare FSA contributions for dependents.
 
For your organization, have increased contribution limits been vetted?*
 
 
 
 
 
 

Miscellaneous
 
Has you insurance adviser discussed Washington’s proposed changes to the Affordable Care Act with you and their possible impact? How confident are you that your organization is well-informed with proactive and strategic direction?
 
 
 
 
How confident are you that you have a policies and procedures are in place as they relate to a pandemic crisis? Particularly Employee Handbooks to include; Return to Work, Paid Sick Leave and FMLA Policies.
 
 
 
 
Has your organization had a strategic discussion around offering a non-competitive “magnet” plan within your industry, including spousal carve out, surcharges and / or spousal and dependent affidavits?*