This SOP defines the compliance checklist that each participating employer must complete before their plan effective date (go-live) and the ongoing compliance obligations they must maintain annually as a participating employer in the Unity Care Member Plan Master Trust. Completion of this checklist is a condition of participation.
Applies to all new and existing participating employer groups. Each employer is the ERISA Plan Administrator for its own employees. This checklist covers ACA, HIPAA, COBRA, No Surprises Act (NSA), and related federal notice requirements. Operations coordinates completion; employers and their HR representatives are responsible for execution.
| Role | Responsibility |
|---|---|
| Operations | Issue checklist to new employers; track completion; block go-live until all items confirmed; maintain employer compliance files. |
| Compliance | Advise on regulatory requirements; confirm BAA list completeness; confirm annual filing status. |
| Employer HR / Plan Administrator | Complete all checklist items; provide documentation confirming completion; distribute required notices to employees. |
| COBRA Administrator (Varipro) | Confirm COBRA setup for each new employer group upon notification from Operations. |
| Legal Counsel (Dickinson Wright PLLC) | Available for employer escalations on ACA status determination, MHPAEA analysis, or NSA obligations. |
| ☐ | Compliance Item | Owner | Required By | Status / Notes |
|---|---|---|---|---|
| ☐ | ACA — ALE Status Determination Employer determines whether it is an Applicable Large Employer (50+ FTEs, including FTE equivalents). ALE status determines ACA employer mandate obligations (Form 1094-C / 1095-C). If not ALE, document the determination. If ALE, confirm ACA reporting vendor in place. |
Employer HR / Benefits Consultant | Before go-live | ___________ |
| ☐ | HIPAA — Privacy Notice Distributed HIPAA Notice of Privacy Practices (NPP) distributed to all employees at enrollment. Employer retains proof of distribution. NPP must identify the plan's privacy contact and describe employee rights under HIPAA. |
Employer HR | At enrollment | ___________ |
| ☐ | COBRA — Varipro Setup Complete Operations notifies Varipro of new employer group. Varipro confirms employer is registered, COBRA premium schedules are set, and qualifying event notification procedures are established. General COBRA notice must be distributed to newly covered employees and spouses within 90 days of coverage start. |
Operations / Varipro | Before go-live; General Notice within 90 days | ___________ |
| ☐ | NSA — Patient Protection Notice Posted No Surprises Act patient protection notice (balance billing protections) posted on employer's plan website or in SPD. Confirms employees' right to a cost estimate and protection from surprise bills. |
Employer HR / Operations | Before go-live | ___________ |
| ☐ | ACA — Exchange / Marketplace Notice at Hire Written notice of Health Insurance Marketplace coverage options provided to all new hires within 14 days of hire date (FLSA §18B requirement). Employer uses DOL model notice. |
Employer HR | Within 14 days of each hire | ___________ |
| ☐ | CHIP Notice — State Children's Health Insurance Program Annual CHIP notice provided to employees describing premium assistance programs available in the employer's state. Distribute at enrollment and annually thereafter. |
Employer HR | At enrollment; annually | ___________ |
| ☐ | WHCRA Notice — Women's Health and Cancer Rights Act Annual notice of rights under WHCRA (mastectomy reconstructive benefits) provided to plan participants. Must be included in or distributed with the SPD and annually thereafter. |
Employer HR / Operations (via SPD) | At enrollment; annually | ___________ |
| ☐ | BAA List — Business Associate Agreements Complete Compliance confirms that all vendors handling PHI on behalf of the plan have an executed BAA on file (Allied Benefit Systems, ProAct, HealthEquity, Varipro, Gradient AI, and any employer-level vendors with PHI access). No PHI may be shared with a vendor absent a BAA. |
Compliance / Operations | Before go-live | ___________ |
| ☐ | SPD / SBC Distributed to All Enrollees Employer confirms SPD and SBC have been distributed to all enrolled employees per OPS-SOP-022 requirements. |
Employer HR | Within 90 days of plan start | ___________ |
| ☐ | Enrollment Data Submitted to Allied Complete and accurate enrollment data submitted to Allied Benefit Systems. Operations confirms Allied enrollment reflects the employer's census. |
Operations / Allied | Before go-live | ___________ |
Each participating employer must maintain the following compliance items on an ongoing and annual basis. Operations tracks these items through the compliance calendar (OPS-SOP-021).
| ☐ | Compliance Item | Owner | Frequency / Deadline | Status / Notes |
|---|---|---|---|---|
| ☐ | ACA Reporting — Forms 1094-C / 1095-C (ALEs only) ALE employers file Forms 1094-C and 1095-C with IRS and distribute 1095-C to employees. Operations confirms employer has ACA reporting vendor in place. Tracked in compliance calendar. |
Employer / ACA Reporting Vendor | March 31 (IRS filing); January 31 (employee copies) | ___________ |
| ☐ | Annual Compliance Calendar Items Tracked All employer-level compliance deadlines (CHIP notice, WHCRA notice, HIPAA NPP renewal, NSA notice review) are entered in the compliance calendar. Operations confirms with employer HR annually. |
Compliance / Operations | Annually (plan year start) | ___________ |
| ☐ | Broker Compensation Disclosure Received Broker/consultant compensation disclosure (CAA §202, ERISA §408(b)(2)) received from each broker or consultant receiving $1,000+ in compensation. Operations retains on file. Plan fiduciaries must review for reasonableness. |
Operations / Broker | Annually; within 60 days of contract execution or renewal | ___________ |
| ☐ | Gag Clause Attestation — Confirmed and Filed Annual gag clause prohibition compliance attestation submitted to CMS confirming the plan has no contracts that prevent sharing cost, quality, or claims data. Due December 31 annually. |
Operations / Compliance | December 31 annually | ___________ |
| ☐ | MHPAEA Comparative Analysis on File Non-Quantitative Treatment Limitations (NQTL) comparative analysis completed for the plan year, documenting that mental health / substance use disorder benefits are not more restrictive than medical / surgical equivalents. Available upon request by participants or regulators. |
Operations / Legal Counsel / Allied | Annually; updated on plan design change | ___________ |
| ☐ | HIPAA Privacy Notice — Annual Review HIPAA NPP reviewed and updated as needed. If revised, redistributed to all plan participants. No revision needed: document review date on file. |
Compliance / Employer HR | Annually | ___________ |
| ☐ | CHIP Notice — Annual Distribution CHIP premium assistance notice redistributed to all employees annually. |
Employer HR | Annually | ___________ |
| ☐ | BAA List — Annual Review Compliance reviews the BAA list for all active plan vendors. Confirms executed BAAs are current and cover all data flows. Any new vendor with PHI access added to the list before data sharing begins. |
Compliance | Annually | ___________ |
Operations maintains a completed, signed copy of the onboarding checklist for each employer in the employer compliance file. The employer HR contact or Plan Administrator must sign the completed checklist confirming all items are satisfied before go-live approval is granted.