Group Health Plan Compliance Risk Assessment

Group Health Plan Compliance Risk Assessment

As your organization manages the increasing complexity of employee benefit regulations, this assessment will help identify potential compliance risks across key areas — including COBRA administration, Medicare coordination, Part D notices, offboarding communications, and employee education.Complete this short questionnaire to evaluate your current compliance posture and assess your readiness for regulatory scrutiny. The insights gathered can help strengthen your plan strategy, reduce liability, and support proactive audit preparedness.
Please select the boxes of the items that you do not have a solution for or know the process:
Medicare Secondary Payer (MSP) & Section 111 Reporting

Do we know who our Responsible Reporting Entity (RRE) is for MSP Section 111 reporting?Are we actively reporting required data to CMS on time and accurately?Have we reviewed our group health plan (GHP) design to ensure it doesn't violate MSP rules?Are we confident our team understands when our plan pays primary vs. secondary to Medicare?Do we have a process for reimbursing CMS promptly if an improper payment occurs?
Form CMS-L564 & Medicare Enrollment

Do we accurately complete Form CMS-L564 when requested by employees?Are we educating employees about the risks of delaying Medicare enrollment?Do we understand the rules for Special Enrollment Periods (SEPs) and how our information may affect employee eligibility?
Medicare Part D Creditable Coverage

Are we notifying all Medicare-eligible employees annually about whether our prescription drug coverage is creditable?Have we submitted our annual disclosure to CMS about creditable coverage status?Is our benefits team trained to handle questions about Part D penalties and coordination?
Domestic Partnership & Medicare Coordination

Do we offer benefits to domestic partners, and if so, do we know how this may impact Medicare coordination?Have we reviewed applicable state laws and updated our benefit materials accordingly?Are we disclosing how domestic partner coverage may or may not qualify as creditable coverage under Medicare rules?
SSA POMS HI 00805.384 & SEP Exposure

Are we confident that we've never misrepresented Medicare enrollment timelines or obligations to an employee?Have any employees missed their Medicare enrollment windows due to lack of information from our organization?Do we have a documented process to provide accurate, timely guidance to employees as they approach Medicare eligibility?
General Compliance & Risk Preparedness

Are we tracking and meeting deadlines for Form 5500, SBCs, and all required Medicare notices?Do we conduct regular internal compliance reviews related to Medicare, COBRA, and ACA?If we were audited by CMS or the DOL tomorrow, would we be ready with documentation and processes?
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Confidentiality & Consent Statement
Your responses are completely confidential. All information submitted through this survey is used solely for internal assessment purposes and will not be shared, distributed, or disclosed to any third parties. Individual results will remain private.

By submitting this survey, you become eligible for a complimentary compliance review with an Aevitas consultant to identify potential gaps, answer questions, and explore tailored strategies to protect your organization.
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