Recent written audit requests to health and welfare plans from the U.S. Department of Labor (DOL) have included inquiries related to various mandates under the Affordable Care Act (the ACA or the Act). This is a significant development in the ongoing implementation of the ACA’s various coverage and related mandates, in that it marks the first appearance of ACA-related topics in DOL auditing practices. While the recent U.S. Supreme Court oral arguments caused speculation as to the future of the ACA, unless and until the ACA is ruled unconstitutional by the Supreme Court, the Act is enforceable and will be enforced by the DOL. Thus, employer-provided group health plans must continue to comply and otherwise implement the ACA’s various coverage and related mandates. Likewise, plan sponsors must comply with any ACA-related DOL audit requests, and be prepared to produce documents to prove that their plan complies with the ACA’s various mandates.

Areas Addressed in Audits:

The DOL audit requests relating to the ACA can be divided into three types: (1) requests as to plans claiming grandfathered status; (2) requests as to plans not claiming grandfathered status; and (3) requests as to all health plans regardless of grandfathered status.

Generally, plan sponsors and administrators must be able to demonstrate that their plans comply with the ACA, which requires documentary evidence – from plans, record keepers, and/or service providers.