Don’t Forget to Distribute Required Notices this Open Enrollment

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With open enrollment fast-approaching for many employers, it is a good time to review what materials are necessary for open enrollment and what employer notices are required to distribute and when.  Some employer notices are provided when participants first become covered under a health and welfare plan and others have an annual distribution requirement.

In some cases, employers may choose to rely on a third party (e.g., COBRA administrator, insurance carrier, etc.) to prepare and/or provide some of the notices described above. Ultimately, the requirement to provide notices falls on the employer, and failure to provide the required notices timely may result in penalties for the employer.

The following list provides details regarding some of the more common employer notices related to health and welfare plans as they may apply to the employer offerings. In addition to the due dates listed below, all notices are required to be provided upon request.  The amount of time to respond can vary, so prompt attention to requests for information is best practice.

 

Notice

Explanation of Notice

Notice Regarding Availability of Health Insurance Marketplace (Exchange Notice)

Due within 14 days of hire

The Exchange Notice must be provided to all new hires. This notice provides information on the health insurance options available on the Exchange, as well as the impact of enrolling in the Exchange rather than any available employer-sponsored plans. This notice must be provided within the first 14 days of employment.

Notice of Health Insurance Portability and Accountability Act (HIPAA) Special Enrollment Rights

Due at or before an employee is initially offered the opportunity to enroll in a group health plan. (Best practice: include in open enrollment materials)

Employers must provide each eligible employee with this notice at or before the time an employee is initially offered the opportunity to enroll in a group health plan. This notice may be incorporated into the plan’s Summary Plan Description (SPD).

Many employers prefer to include this notice annually during open enrollment to ensure that employees understand their enrollment rights.

Summary of Benefits and Coverage (SBC)

Due at initial enrollment, special enrollment and annually (open enrollment)

The Affordable Care Act requires health plans and health insurance carriers to provide an SBC to employees and participants explaining the benefits offered under the plan. The SBC should be included with plan application materials during open enrollment. If coverage automatically renews for participants, the SBC must be provided no later than 30 days prior to the start of the new plan year.  For special enrollees you must provide within 90 days of their special enrollment.  The SBC must be provided 60 days in advance of any mid-year change to the plan.

Medicare Part D Notice of Creditable/Non-Creditable Status

Due annually, no later than October 15th

Employers with group health plans that cover prescription drugs must provide an annual notice to Medicare Part D eligible participants informing them about whether the employer-sponsored prescription drug coverage is “creditable” or “non-creditable.” “Creditable” coverage means that the employer-sponsored coverage is at least as good as Medicare Part D coverage. This notice must be provided when a participant first enrolls in the plan and then annually before October 15th (when Medicare annual open enrollment begins).

Women’s Health and Cancer Rights Act (WHCRA) Notice

Due upon enrollment and annually thereafter (open enrollment)

Employers must provide notice to group health plan participants regarding their rights to mastectomy-related benefits under the WHCRA at the time they enroll in the plan and on an annual basis thereafter.

Children’s Health Insurance Program (CHIP) Notice

Due at time of initial enrollment and annually (1st day of each plan year, often distributed during open enrollment)

Employers with group health plans that cover residents in a state that provides a premium subsidy to low-income children and their families to help defray the cost of employer-sponsored health insurance coverage must provide an annual notice about the premium assistance to employees residing in that state.

Grandfathered Plan Notice

Due whenever a summary of the plan benefits are provided. Includes initial eligibility and open enrollment, if applicable

Employers with a grandfathered health insurance plan must include information about the plan’s grandfathered status in documents describing coverage under the plan, including SPDs and open enrollment materials. Since the Affordable Care Act (ACA) has been in existence since 2010, grandfathered plans are uncommon.

Patient Protections Notice

Due whenever SPD or similar description of plan benefits is provided (consider in open enrollment materials with SBC)

Group health plans that require the designation of a primary care physician (PCP) must include this notice anytime an SPD or similar description of benefits are provided to participants. The notice identifies what types of providers meet the plan requirements of a PCP, such as pediatricians and/or obstetrical or gynecological providers.

Initial COBRA Notice

Due within 90 days of enrollment in a COBRA eligible plan

Employers with 20 or more employees who are subject to COBRA and who sponsor group health plans must provide an initial COBRA notice to new participants and their covered dependents within 90 days after commencement of coverage under the plan. This notice is required to be distributed to both employees as well as dependents who enroll in COBRA-eligible plan.

Summary Annual Report (SAR)

Due annually, within 9 months of the close of the Plan Year or 2 months following extension if applicable

Employers that are required to file a Form 5500 must provide participants with SAR, which is a summary of the information contained in the Form 5500. The SAR must be provided within 9 months of the close of the plan year. If the employer received an extension to file the Form 5500, then the SAR is due within 2 months after the close of the extension period.

HIPAA Privacy Notice

Due upon enrollment, within 60 days of a material change and at least every three years thereafter.

(Note: Privacy notices were updated with HITECH in 2013. If notice has been distributed every three years, it would be due in 2019.)

Employers with self-insured health plans must provide this notice to new participants when they enroll. In addition, at least once every 3 years, employers must either redistribute the HIPAA Privacy Notice or a Notice of Availability of a Notice of Privacy Practice to inform participants that the notice is available and how they can procure a copy. In the case of fully-insured plans, the insurance carrier and not the employer is responsible for providing the HIPAA Privacy Notice.

Summary Plan Description (SPD)

Due within 90 days of enrollment in an existing plan or 120 days after a new plan is established. In addition, at least every 5 (if plan changes occurred) or 10 (if no plan changes) years thereafter.

Employers must provide an SPD to new plan participants within 90 days after plan coverage begins. An updated SPD must also be furnished every 5 years if changes are made to the SPD or if the plan is amended. If there are no changes, a new SPD must be provided to participants every 10 years.

Summary of Material Modification (SMM)

Due 210 days following the end of the plan year in the year there is an amendment if there are plan changes.

Employers must provide an SMM to health and welfare benefit plan participants when a significant change is made to the plan’s terms or coverage.

Summary of Material Reduction in Covered Services or Benefits

Due within 60 days after the date of the adoption of the change, or within 90 days by a system of communications that provides regular, periodic information about the plan.

Employers must provide a Summary of Material Reduction in Covered Services or Benefits to health and welfare benefit plan participants when any reduction or elimination of benefits occurs. This would include new conditions or requirements (such as addition of pre-authorizations for services).

HIPAA Wellness Program Notice

Due prior to wellness plan participation and anytime a description of the wellness program is distributed

Employers with health-contingent wellness plans that require individuals to satisfy a standard related to a health factor (e.g., not smoking) in order to obtain a reward must provide employees with a notice disclosing the availability of a reasonable alternative standard (and/or a waiver of the original standard) to qualify for the reward in all plan materials describing the terms of the wellness plan. This notice should be provided to participants before they divulge any health-related information or undergo medical examinations.

Americans with Disabilities Act (ADA) Wellness Program Notice

Due prior to wellness plan participation and anytime a description of the wellness program is distributed

Employers with 15 or more employees who are subject to the ADA and who have wellness programs that include health-related questions or medical examinations must give participating employees a notice telling them what information will be collected as part of the wellness program, with whom it will be shared (and for what purpose), any limits on disclosure and how the information will be kept confidential. This notice should be provided to participants before they answer any health questions or undergo any medical examinations.

Michelle’s Law Notice

Employers with group health plans that condition dependent eligibility on a child’s full-time student status must provide a notice about Michelle’s Law in plan materials that describe the requirement for certifying student status for plan coverage. Michelle’s Law prevents plans from terminating a child’s coverage due to loss of full-time student status when the change in status is due to a medically necessary leave of absence. Due to the ACA’s requirement that children be eligible for coverage on their parent’s health plan through age 26, plans that condition dependent eligibility on full-time student status and which are therefore subject to Michelle’s Law are rare.

 

 

Categories: Benefits in General, Compliance | Tags: Notice , Compliance , Benefits , SPD , SMM , SBC , SAR , Medicare Part D , Notice of Creditable Coverage , COBRA , HIPAA , CHIP , WHCRA , Wellness , ADA , Grandfathered Plan , Michelle's Law | Return