I still remember that day over a decade ago, when I was opened my mail. Invoices … advertisements … a few benefit issues … and then wham! I held an official-looking letter from the Department of Labor. Winner Winner Chicken Dinner — I’d won the privilege of a health plan audit!
Despite digging up six years’ worth of documents (from mounds of storage boxes in the attic), constant communications with legal, copies and more copies, plus interviews that made me nervous, it was one of the most positive and influential moments in my career. The field auditor assigned was not only knowledgeable, but helpful, too. Yes, you read that correctly: Helpful. The auditor took the time to explain the reasoning behind regulatory requirements (such as summary plan description language), self-insured plan designs and required ERISA lingo. The audit turned out well, but more importantly I discovered a new knowledge resource I could count on.
Over the years, I’ve come up with several unusual benefit questions or programs I wished to implement. While I usually consult with outside counsel, I don’t miss a beat when it comes to asking advice from my regional
I’ll give you a few examples of how they helped me in my prior HR roles. There was the time we chose to offer a non-smoking family discount on our medical premiums as part of a wellness program. The EBSA gave me the green light and thoroughly explained how to design the program so we would be compliant with nondiscrimination rules. Folks at the DOL also described restrictions with fully insured plans — and boy, were they complicated! Fortunately for me, our plan was self-insured. During the next open enrollment, tobacco cessation affidavits started rolling in. The EBSA even helped me with craft a few responses to some not-so-happy health plan members who didn’t qualify for the smoking discount. (Of course, I highly recommended our smoking cessation program.)
Raise your hand if you love appeals. C’mon, anyone? The appeal process can be tricky. Early in my career, my pals at the EBSA walked me through the process and provided guidance on numerous occasions.
Then there was the time I decided that I needed to get more of my health plan members into disease management programs, such as diabetes, back pain, and cardiac health. We suffered from low participation and the reason was two-fold: One, the enrollment triggers were prescriptions or medical claims and both experienced data delays; and two, we employed a large number of veterans who used free or low-cost medications from the local VA hospital. The carrier’s health risk assessment was a great solution because it allowed for immediate enrollment into disease management.
EBSA to the rescue! They helped me craft language for my SPD which required completion of a health risk assessment as a condition of eligibility. Both members and their spouses were required to complete an assessment within 45 days of initial enrollment, and annually. If not, they were dropped from the health plan. It was a bold move six years ago, and the process was more painful to administer than I can covey in this blog, but it was well worth it as disease management enrollments more than tripled.
Don’t be afraid to reach out talk to your local EBSA office when complications arise, or you have benefit questions on your mind — they are definitely a fantastic resource to have on your side!
Karrie Andes, SPHR, CBP, is the Sr. Benefits Manager for
Do you talk to EBSA on a regular basis? Share your experiences in the comments.
