DOL Health Plan Audit Toolkit: What EBSA Asks For and How to Prepare
When the Department of Labor opens an investigation of an employer health plan, the first letter lists the documents it wants and sets a deadline. This toolkit shows what is usually on that list, how to build the file before the letter arrives, and what to do in the first week after it does.
Related: mid-year benefits compliance check-in.
What an EBSA Request Usually Covers
The Employee Benefits Security Administration (EBSA) is the part of the Department of Labor that enforces ERISA. Every request is different, but health plan investigations tend to ask for the same six groups of records.
Plan Documents
The written plan document, the summary plan description (SPD), every amendment and any summaries of material modification, plus the wrap document if several benefits sit under one plan.
Filings
Form 5500 with all schedules for each year in question, summary annual reports, and proof of when each was filed and furnished.
Contracts and Fees
Carrier, third-party administrator and pharmacy benefit manager contracts, service agreements, and the fee and commission disclosures from each vendor.
Fiduciary and Money Records
Who the named fiduciaries are, committee minutes if any, the ERISA fidelity bond, and how employee premium contributions were collected and paid to the carrier.
Notices and Compliance Proof
COBRA and HIPAA notices, SBCs, mental health parity analysis, the gag clause attestation, prescription drug reporting, and claims and appeals procedures with sample denial letters.
Participant Communications
Enrollment materials, open enrollment notices, and any written answer given to employees about what the plan covers.
Build the Audit File in Four Steps
An organized file turns a two-week scramble into an afternoon of copying. Most of this material already exists; the work is putting it in one place.
1. Name One Owner
Pick one person who holds the file and answers the request, and one backup. Record who your named fiduciaries are in writing.
2. Collect and Label
Create one folder per document group above, one subfolder per plan year, and a short index listing each document and its date. Federal law requires keeping the records behind your filings for six years.
3. Close the Gaps
Where an item is missing, such as an unsigned amendment or a notice with no proof of delivery, fix it now. If a filing or a plan document is missing altogether, a correction program may be available.
4. Review Every Year
Add the new plan year at renewal and check the file against your compliance calendar so deadlines are not missed.
The First Seven Days
A DOL request is not a verdict, but the deadline on it is real. These are the steps that keep a routine review routine.
Read and Date It
Note the deadline, who signed the letter, what years and plans it covers, and whether it asks for documents, an interview or both. Send the letter to your broker and benefits attorney the same day.
Ask in Writing if You Need Time
If the deadline cannot be met, ask the investigator for an extension in writing before it passes, and say which items you can send now.
Send a Complete, Indexed Response
Produce the documents in the order requested, keep an identical copy of everything sent, and have counsel review it before it goes out.
Common Questions
What triggers a DOL investigation of a health plan?
Investigations can come from a participant complaint, a late or missing Form 5500, a referral from another agency, or a planned enforcement project. A complaint from an employee is a common starting point.
How long do I have to answer an EBSA document request?
The deadline is written in the letter and is usually short. If you need more time, ask the investigator in writing before it passes.
Which records must I keep, and for how long?
ERISA requires keeping the records that support your filings for at least six years after the filing date. Keep plan documents and amendments for as long as the plan exists.
Can small employers be investigated?
Yes. Plan size does not exempt a plan from ERISA investigation authority, although some small plans are exempt from filing Form 5500. Having the file ready costs little either way.
Where These Rules Come From
29 U.S.C. §1134 (ERISA §504, Investigative Authority)
29 U.S.C. §1027 (ERISA §107, Retention of Records)
29 U.S.C. §1112 (ERISA §412, Bonding)
U.S. Department of Labor, Employee Benefits Security Administration
CFH are licensed insurance brokers, not attorneys. This page is general information, so confirm your situation with your benefits attorney, especially once you have received a government letter.
Related Guides
DOL Rules for Employer Health Plans
The federal rules an investigator measures your plan against.
Prescription Drug Reporting and Gag Clause Attestation
Two annual compliance items an investigator may ask about.
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