The Compliance Maze: Where To Start In Health Benefits

In the ever-evolving landscape of employee health benefits, staying compliant is not just a best practice—it’s a necessity. Navigating the compliance maze can be challenging, but by arming yourself with the knowledge of what to expect, health benefits advisors, business owners, and HR team members can ensure their clients or employees move smoothly through regulatory twists and turns.

Understanding the Landscape

Several key regulations shape the landscape of the Health Benefits maze. The Affordable Care Act (ACA), Health Insurance Portability and Accountability Act (HIPAA), and Employee Retirement Income Security Act (ERISA) are among the critical statutes impacting benefits design and administration. Unraveling their intricacies is the first step to ensuring compliance. Each regulation deserves its own deep dive, but knowing what you are up against and hearing some of the terms is a great place to get started.

Changes and Updates

In an era where regulatory changes are as certain as the sunrise, staying informed is non-negotiable. Business owners, health benefits advisors, and anyone else in the industry must adopt a proactive approach to monitoring and communicating regulatory updates. The goal here should be to create a specific set of strategies to stay current. Build processes into your weekly or monthly routine to review the news, subscribe to updates, attend webinars, or seek out experts to explain the nuances of evolving compliance requirements.

Common Compliance Challenges

Navigating the compliance maze is fraught with challenges, and there are certain pitfalls that you will want to avoid. Many compliance issues boil down to the more tedious parts of managing health benefits. For example, you may be doing everything correctly with the actions you are taking, but you are not reporting or documenting them properly. Awareness is the first line of defense against these challenges, so do an internal audit of your existing processes regularly. If there are significant questions that haven’t been answered, looking for outside consultation or even legal advice may be advisable from time to time to develop procedures and processes that are repeatable.

Communication and Education

Effective communication and education are powerful tools in the compliance arsenal. Once strategies to track compliance regulation changes and repeatable procedures to avoid specific pitfalls are in place, the advisor and business owner take on the role of educators to their clients and employees. The leadership team must ensure that the end users are well-informed about their benefits and how compliance fits into them. Running onboarding training, doing periodic check-ins, and providing access to documentation are all proven ways to communicate information successfully. Transparent communication builds trust and compliance hand-in-hand.

Embracing compliance as a strategic asset will put you on the path to maintaining resilient and successful health benefit plans. Advisors and business owners who have a proactive and informed approach realize that compliance is not just a legal obligation—it’s a cornerstone for building trust and fostering long-term relationships. In the end, if you can educate yourself, build strategies to stay ahead of changes, create repeatable processes and procedures, and educate your end user you will have successfully navigated the maze and brought everyone with you.