When most people hear “healthcare compliance,” they think of clinical standards, patient safety laws, or HIPAA regulations for providers. But for employers—especially those offering health benefits to their workforce — compliance takes on a broader, more administrative meaning.

Let’s walk through the most pressing regulations, the challenges HR teams face in staying compliant, and how technology solutions like Selerix’s Healthcare Compliance platform and support can help reduce complexity, automate reporting, and avoid costly penalties.

What Is Healthcare Compliance?

In the context of the workplace, healthcare compliance refers to the ongoing process of meeting the legal, ethical, and professional standards that apply to healthcare organizations and employers offering health benefits. For providers, this includes regulations around patient care and billing. For employers, it’s about offering compliant benefits, protecting sensitive employee data, and staying aligned with changing federal laws.

The Scope of Healthcare Compliance

Healthcare compliance affects a lot more than just hospitals and clinics. Any employer that offers health coverage is also responsible for staying compliant with a wide range of regulations. 

This includes:

• ACA requirements like tracking full-time employee status and furnishing 1095-C forms
• HIPAA protections related to employee health information
• COBRA obligations for continuation of coverage after qualifying events
• IRS rules around tax-advantaged benefits like HSAs and FSAs
  

Because these laws change frequently and often intersect in complex ways, compliance can’t be a one-time task. It requires ongoing attention and regular system updates.

Key Laws Governing Healthcare Compliance

• ACA (Affordable Care Act): Requires applicable large employers (ALEs) to offer affordable, minimum essential coverage or face penalties.
  
• HIPAA (Health Insurance Portability and Accountability Act): Sets standards for the privacy and security of protected health information (PHI).
  
• COBRA (Consolidated Omnibus Budget Reconciliation Act): Gives employees the right to continue health coverage after leaving employment.
  
• ERISA (Employee Retirement Income Security Act): Governs employee benefit plans and requires certain disclosures and fiduciary responsibilities.

These laws form the foundation of healthcare compliance in an HR context—yet many teams still struggle to keep up. In the next section, we’ll explore the biggest challenges organizations face today.

The Biggest Compliance Challenges in Healthcare

Healthcare compliance means keeping up with regulations, applying them correctly, and ensuring nothing falls through the cracks. For HR and benefits teams, that’s often easier said than done.

Regulatory Complexity & Constantly Changing Laws

Federal and state laws affecting healthcare benefits are constantly evolving, and staying compliant requires ongoing education and agility. Manual tracking across fragmented systems increases the risk of missed updates and costly errors.

Data Security & HIPAA Compliance

HR departments routinely handle sensitive health information — everything from dependent coverage details to plan utilization data. If that data isn’t secured properly, organizations may find themselves in violation of HIPAA, facing potential fines or audits. Many teams underestimate the scope of PHI and lack the tools to manage it securely — particularly concerning at a time when data security is struggling in general.

ACA & Benefits Compliance

ACA compliance remains one of the most significant administrative burdens for employers. Determining full-time eligibility, tracking hours, managing look-back periods, issuing 1095-C forms, and responding to IRS Letter 226J requires precision. Unfortunately, many HRIS and payroll systems don’t offer the detailed tracking or audit support needed — leaving teams vulnerable to penalties for mistakes they didn’t even know they were making.

Healthcare Compliance & Benefits Administration: The Missing Link

When people hear “healthcare compliance,” they often think of clinical regulations or patient privacy. But for employers and HR teams, compliance obligations extend deep into the world of employee benefits, and overlooking this link can be a costly mistake.

How Benefits Administration Ties Into Compliance

From offering the right coverage to the right employees, to distributing the correct documents on time, HR plays a central role in healthcare compliance. Federal laws like the ACA, HIPAA, and COBRA all place specific obligations on employers — many of which fall directly within the scope of benefits administration. 

That includes:

• Tracking hours to determine ACA eligibility
• Providing timely COBRA notifications
• Managing HIPAA-protected information
• Distributing Summary Plan Descriptions (SPDs) and other required disclosures
• Filing accurate IRS forms (like 1095-C)

This is why access to expert support matters so much. Navigating the complex web of ACA, HIPAA, and COBRA requirements shouldn’t fall solely on overstretched HR teams. Having compliance experts who understand the nuances of evolving regulations can help prevent costly missteps, interpret gray areas with confidence, and provide guidance when new rules emerge.  Whether it’s answering a question about safe harbor methods or reviewing your 1095-C filings, the right partner (like Selerix) makes all the difference between managing risk and flying blind.  

Common Compliance Issues in Benefits Administration

Even well-intentioned teams can run into trouble with healthcare compliance. Some of the most common issues include:

• Misclassifying employees (e.g., full-time vs. part-time)
• Missing enrollment deadlines or notices
• Errors in 1095-C forms or ACA filings
• Failing to properly track leave or coverage periods
• Storing or transmitting PHI without adequate protections

Each of these errors carries potential fines, audit exposure, and employee frustration. And as healthcare laws continue to evolve, the stakes are only getting higher.

Healthcare Compliance Best Practices for Employers & HR Teams

Staying compliant in today’s healthcare environment demands proactive planning, real-time monitoring, and the right tools to support your team. Below are three proven strategies to help HR leaders reduce risk and strengthen their compliance posture.

1. Stay Informed About Regulatory Changes

Laws like the ACA, HIPAA, and COBRA often evolve with policy updates, court rulings, and IRS guidance. It’s important to keep current with requirements to avoid fines or penalties. 

To stay compliant:

• Subscribe to updates from authoritative sources like CMS, DOL, and IRS
• Work with legal counsel or benefits consultants for the interpretation of complex rules
• Schedule quarterly internal audits or compliance reviews
• Work with your Selerix ACA team to stay current on requirements and best practices, including quarterly compliance check-ins and resources that will help stay ahead of change.

2. Leverage Compliance Software to Reduce Errors

Manual compliance tracking is prone to mistakes, especially when managing multiple employee classes, benefit tiers, or eligibility rules. Compliance software automates and safeguards key processes such as:

• ACA eligibility tracking and reporting
• HIPAA data security protocols
• COBRA communication and timelines
• IRS form generation and error detection
  

3. Improve Employee Education & Communication

Employees can inadvertently trigger compliance issues by missing deadlines, misunderstanding coverage, or improperly submitting PHI. Educating them is smart risk mitigation.

• Use clear, jargon-free communication across multiple channels (email, SMS, intranet)
• Offer live Q&A sessions or open enrollment webinars
• Provide secure self-service tools for updates and questions

Tip: With Selerix Engage, HR teams can schedule targeted communications, send automated reminders, and track employee engagement with critical compliance messages.

How Selerix Simplifies Healthcare Compliance

Healthcare compliance is complex, but it doesn’t have to be chaotic. Selerix provides a powerful, user-friendly solution that helps HR teams manage compliance tasks with more confidence and less manual work, while protecting their organizations from costly errors.

Automating ACA Compliance & Benefits Tracking

Tracking ACA eligibility can quickly become overwhelming, especially for employers managing variable-hour or seasonal workforces. Selerix automates this process by monitoring employee status and hours in real time, surfacing potential compliance issues before they become costly. It simplifies the generation and distribution of 1095-C forms and maintains an audit-ready trail of compliance activity, so you’re always prepared for IRS reporting. With built-in logic and alerting, the platform helps ensure eligibility thresholds and reporting deadlines aren’t missed — no spreadsheets required.

Secure Data Management for HIPAA Compliance

HIPAA compliance means knowing exactly who can access what, and when. Selerix helps safeguard employee health data through secure, cloud-based infrastructure that meets rigorous privacy standards. Access is role-based, ensuring only authorized users can view or modify sensitive information, and every action is logged for traceability. Authentication protocols and encrypted communication channels protect employee data at every step, so HR teams can manage benefits without compromising compliance.

Real-Time Monitoring & Expert Support

Compliance isn’t static, and neither is Selerix. With customizable dashboards, alerts, and quarterly reviews, the platform gives HR teams visibility into evolving risks and regulatory changes. All activity is documented and stored for easy retrieval in the event of an audit. And when new laws or requirements emerge, Selerix updates the platform accordingly and supports clients with expert guidance, so you never have to navigate complex changes alone.

Take the Next Step: Simplify Healthcare Compliance with Selerix

Keeping up with healthcare compliance requirements doesn’t have to be a scramble. With Selerix Healthcare Compliance support, HR teams gain a partner that helps automate the most time-consuming compliance tasks, reduce costly errors, and maintain visibility into every part of the benefits process, from ACA reporting to HIPAA safeguards.

Whether you’re navigating new regulations or trying to streamline what’s already in place, Selerix delivers the tools, expertise, and support to help you move forward with confidence.

Explore how Selerix Healthcare Compliance solutions can help your team stay compliant, efficient, and audit-ready, without the stress.