How SimplyHRA Ensures Compliance with Healthcare Regulations

Navigating the maze of healthcare regulations can be a headache for small businesses. From HIPAA to the Affordable Care Act (ACA), keeping up with ever-changing rules is no small feat. The stakes are high—non-compliance can lead to hefty fines and legal troubles. That’s where SimplyHRA comes in. We handle the compliance details so you can focus on growing your business. But how exactly do we ensure you stay on the right side of the law? Let’s dive in.

Why Compliance Matters for Small Businesses

Staying compliant isn’t just about avoiding fines—it’s about safeguarding your employees’ well-being and your company’s reputation. Non-compliance can lead to:

• Hefty Penalties: Hefty penalties can apply for certain group health plan compliance failures. For example, some failures to comply with ACA market reform requirements can trigger an IRS excise tax of $100 per day per affected individual under Internal Revenue Code §4980D. Separately, Applicable Large Employers (ALEs) can face ACA employer shared responsibility payments under different rules and formulas.
• Legal Liabilities: Employees could sue for benefits mismanagement, leading to costly legal battles.
• Employee Dissatisfaction: Compliance ensures employees receive their entitled benefits, boosting morale and retention.

SimplyHRA understands these stakes and takes a proactive approach to keep your business compliant and your employees happy.

How SimplyHRA Ensures Compliance

ICHRA Compliance Made Practical

ICHRAs are governed by federal rules from multiple agencies (including IRS, DOL, and HHS), and they interact with Affordable Care Act (ACA) requirements like affordability and other market reform standards. Non-compliance can result in significant penalties. Here’s how SimplyHRA makes ACA compliance a breeze:

• Automatic Affordability Checks: We help you estimate ICHRA affordability using the required inputs (like the employee’s location/rating area, the self-only lowest-cost silver plan available to them, the ICHRA amount, and the IRS affordability percentage that changes year-to-year). Employers remain responsible for applying the rules and any applicable safe harbors to their workforce.
• IRS Reporting: If you're an Applicable Large Employer (ALE), we can help you organize and export the data you’ll typically need for Forms 1094-C and 1095-C. Your organization (and/or your tax advisor, payroll provider, or ACA reporting vendor) remains responsible for preparing and filing the forms.
• Eligibility Tracking: We keep track of employee eligibility and status changes, reducing administrative burden.

This automated approach minimizes human error and keeps your business compliant without the headache.

HIPAA Compliance for Data Security

Depending on how your health plan is structured and administered, HIPAA privacy and security rules may apply to the plan’s protected health information (PHI). (For example, certain small group health plans with fewer than 50 participants that are administered solely by the employer are not HIPAA covered entities.)

• Secure Data Storage: We use common security and privacy safeguards (such as role-based access controls and training) designed to reduce risk when handling sensitive benefits information. HIPAA applicability and compliance obligations depend on the employer’s plan structure and administration, and employers remain responsible for meeting their specific legal requirements (including any required agreements and policies).
• Restricted Access: Only authorized personnel have access to sensitive information, reducing the risk of data leaks.
• Employee Training: Our team is trained in HIPAA compliance, ensuring data is handled responsibly and securely.

These security measures not only keep your business compliant but also protect employee privacy.

ERISA Compliance and Plan Documentation

For most private-sector employers, HRAs are treated as Employee Retirement Income Security Act (ERISA) welfare benefit plans and typically require written plan terms and employee disclosures (like a Summary Plan Description). ERISA rules don’t apply to every type of employer, and documentation requirements can vary based on plan structure. SimplyHRA ensures compliance by:

• Custom Plan Documents: We can provide plan document and SPD templates intended to help support common ERISA documentation and disclosure workflows.
• Summary Plan Descriptions (SPDs): Employees receive easy-to-understand SPDs, fulfilling ERISA disclosure requirements.
• Ongoing Updates: We update plan-document templates and guidance as rules change to help you keep documentation current.

This thorough documentation process minimizes legal risks and keeps your ICHRA in line with ERISA rules.

Staying Ahead with Regulatory Updates

Healthcare regulations are constantly changing, and staying informed can be overwhelming. SimplyHRA keeps you ahead by:

• Regulatory Updates: We monitor major federal developments that can affect HRAs and update product guidance and features as appropriate. Some changes may require employer decisions (such as plan amendments, notices, or new administrative steps).
• Expert Guidance: Our compliance experts are available to answer questions and guide you through complex regulations.
• Continuous Education: We provide educational resources to keep you and your team informed about compliance requirements.

This proactive approach helps you avoid compliance pitfalls before they become costly issues.

Why SimplyHRA Is Your Compliance Partner

Navigating healthcare regulations can be complex, but it doesn’t have to be. SimplyHRA takes the burden off your shoulders by:

• Automating Compliance Checks: Our software can help you manage and document key compliance workflows—like estimating ACA affordability based on available inputs, supporting plan documentation processes, and tracking employee status changes that can affect eligibility. HIPAA and COBRA obligations depend on your plan structure and employer circumstances, and we help you organize information and next steps where applicable.
• Expert Support: Our compliance team stays updated on regulatory changes so you don’t have to.
• Cost-Effective Support: SimplyHRA helps streamline common compliance workflows and reduces administrative burden. Employers remain responsible for their plan’s compliance, and some situations may still warrant advice from legal or tax professionals.

With SimplyHRA, you can confidently offer ICHRA benefits while staying fully compliant with federal and state regulations.

Ready to Simplify Compliance?

Compliance doesn’t have to be complicated. SimplyHRA makes it easy for small businesses to offer flexible, affordable health benefits without the legal headaches. From ACA affordability support to privacy/security safeguards and tracking eligibility changes that can affect continuation rights, SimplyHRA helps you manage key administrative and compliance-related workflows. Coverage of specific obligations (including COBRA) depends on your employer size, plan design, and circumstances.

Want to learn more about how SimplyHRA can keep your business compliant? Schedule a demo or sign up for an employer account today!

SimplyHRA—making health benefits simpler and helping employers stay aligned with key compliance requirements.

Frequently Asked Questions (FAQs) about SimplyHRA Compliance with Healthcare Regulations:

Q: Does SimplyHRA provide guidance on compliance with the Affordable Care Act (ACA)?

A: Yes, SimplyHRA offers comprehensive support to ensure compliance with the ACA, including tracking employee eligibility, generating required IRS forms like 1095-C, and staying updated on changes in ACA regulations. Our platform makes it easy to manage ACA requirements without additional administrative burden.

Q: How does SimplyHRA help with non-discrimination testing for HRAs?

A: SimplyHRA helps you set up ICHRA employee classes and allowance amounts within the structure the ICHRA rules contemplate. Non-discrimination compliance can be fact-specific, so employers should consult their advisor for formal testing or legal determinations where needed.

Q: Can SimplyHRA accommodate changes in employee status, like part-time to full-time transitions?

A: Absolutely. SimplyHRA’s platform automatically adjusts benefit eligibility and compliance requirements based on changes in employee status, such as moving from part-time to full-time, ensuring continued regulatory compliance.

Q: How does SimplyHRA handle COBRA compliance for HRAs?

A: SimplyHRA can help track eligibility changes and provide information needed to support COBRA processes where applicable.

Q: Is SimplyHRA compliant with ERISA requirements?

A: SimplyHRA supports common ERISA documentation and disclosure workflows, but employers remain responsible for their plan’s ERISA compliance.

Q: Does SimplyHRA provide state-specific compliance support?

A: SimplyHRA is designed to support multi-state administration, but state requirements vary and employers may need state-specific guidance. Contact us for assistance.

Q: How frequently does SimplyHRA update its compliance features?

A: SimplyHRA continuously monitors federal and state regulatory changes. Our platform is updated in real-time to reflect new compliance requirements, ensuring your HRA plan remains up-to-date and compliant.

Q: What resources does SimplyHRA provide for staying informed about compliance?

A: SimplyHRA offers educational resources, including webinars, compliance guides, and personalized support from our compliance team, helping employers stay informed about the latest healthcare regulations.

Q: Can SimplyHRA integrate with other HR or payroll systems for better compliance management?

A: Yes, SimplyHRA integrates seamlessly with popular HR and payroll systems, ensuring accurate data synchronization and streamlined compliance reporting. This reduces manual data entry errors and simplifies regulatory audits.

Q: What happens if a compliance issue arises?

A: If a compliance issue is detected, SimplyHRA provides proactive alerts and guidance on corrective actions. Our support team is also available to assist in resolving compliance concerns efficiently.