Compliance Materials

The Affordable Care Act (ACA) requires health plans of all sizes to comply with an overall annual out-of-pocket (OOP) maximum limit on cost-sharing, effective for plan years beginning on or after January 1, 2014. The annual OOP maximum limit applies only to “essential health benefits” that are provided on an in-network basis and is adjusted annually by the Department of Health and Human Services (HHS) according to the premium adjustment percentage (a factor computed according to rules establish

Even when an employer outsources COBRA administration to a third-party administrator (TPA), such as a COBRA vendor, the plan administrator continues to hold direct responsibility for COBRA compliance. The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires employers that sponsor group health plans to offer continuation coverage to employees, their spouses, and their dependent children in certain circumstances under which they would otherwise lose that coverage. Note that gro

HIPAA's requirements vary significantly in their impact on self-insured versus fully insured plans, with greater responsibilities and administrative burdens placed on self-insured group health plan sponsors. Fully insured group health plans must comply with certain provisions as well, though the scope of those requirements will depend on whether the plan handles participant health data. This guide focuses on HIPAA's Administrative Simplification provisions, which were implemented to streamline

The Health Insurance Responsibility Disclosure (HIRD) form is a state reporting requirement in Massachusetts that applies to in-state and out-of-state employers with employees in Massachusetts. Download the Guide

Navigating the Family and Medical Leave Act (FMLA) can be complex--but it doesn't have to be. This downloadable FMLA Checklist is designed to help employers understand and meet their obligations under federal law. Whether you're determining employee eligibility, managing leave requests, or preparing required documentation, this guide offers a step-by-step overview to support compliance and reduce administrative burden. Inside, you'll find: Employer and employee eligibility criteria Requir