Segal Company

Health Plan Compliance

Segal offers a range of compliance services and publications to help public sector entities navigate the maze of federal, state and local laws and regulations related to benefit plans. Our services include:

Policies and Documentation

  • Reviewing documents, policies and administrative processes to ensure that the plan is in compliance with HIPAA
  • Preparing the Summary of Material modification/Summary of material reduction in Covered Services of Benefits
  • Preparing annual notices to employees, including:
    • Summary Annual Report
    • Women's Health and Cancer Rights Act Annual Notice
    • Notice of Creditable Coverage for Medicare Part D
  • Reviewing claims and appeals policies, and discussing any complaints from employees
  • Creating plan documents and COBRA policies for plans with and without HRAs
  • Reviewing subrogation and reimbursement policies, workers compensation and third party liability recovery procedures
  • Reviewing plan design for compliance issues
  • Reviewing Medicare and Medicare Secondary Payer policies, and Coordination of Benefits (COB) in general
  • Ensuring that federally-required policies and procedures are complete and up to date, including Uniformed Services Employment and Reemployment Rights Act (USERRA), Qualified Medical Child Support Order (QMCSO), and Family and Medical Leave Act (FMLA) notices and policies
  • Enabling electronic delivery of notices and plan communications
  • Reviewing policies and procedures meant to safeguard the plan in the event of an Retiree Drug Subsidy (RDS) audit
  • Ensuring that reporting and disclosure notices are up to date and have been sent out as required
  • CrosscheckSM - a benefit administration review for public sector health and welfare plans

Research and Publications

We keep our clients informed about health compliance news through a variety of publications, including:

  • Capital Checkup, a periodic electronic newsletter summarizing activity in Washington with respect to health care and related subjects
  • Compliance Alert, which summarizes important developments affecting benefit plan compliance.