For employers operating their group health and welfare plans beginning on or after January 1, now is the time of the year to prepare for open enrollment. Typically, the focus is on evaluating the services and performance of vendors, renewing rates, and considering design changes. In addition to these items, employers need to address various legal requirements. As you prepare the open enrollment materials do not forget about the required participant notices which must be furnished annually.
- Notice of Grandfathered Status Plans that were in effect prior to the enactment of the ACA in 2010 are exempt from some of the insurance market reforms as long as they retain “grandfathered plan” status (that is, plans that have existed without major changes to their provisions since March 23, 2010, the date of the ACA’s enactment). If your plan is still grandfathered, a notice of grandfathered status must be included in SPDs and other plan materials such as annual open enrollment materials. Click here for the DOL sample notice [PDF].
- Summary of Benefits and Coverage The SBC is intended to provide information in a prescribed format to participants so they can easily compare the information to other plans for which they may be eligible, including coverage on the exchange. A template SBC is available on the DOL website. Click here for the DOL SBC template and instructions.
- Women’s Health and Cancer Rights Act Each year participants must receive a summary of a health plan’s coverage for mastectomies and breast reconstructive services. Click here for the DOL sample notice [PDF].
- Medicare Part D Notice of Creditable or Non-Creditable Coverage This annual notice must be provided before October 15th to any participant who is eligible for Medicare Part D prescription drug coverage along with any qualified beneficiaries. This includes COBRA participants, retirees, and their dependents and Medicare-eligible employees and their dependents. Since it is difficult for most employers to determine who should receive the notice, providing the notice to all employees facilitates compliance. Click here for the CMS sample notices.
- HIPAA Notice of Privacy Practices Enrolled employees must be notified at least once every three years that they may request a new copy of the HIPAA notice of privacy practices. Alternatively, the notice can be reissued at least once every three years. An easy way to comply with this requirement is to notify participants annually, at open enrollment, that they may request a new copy of the notice at any time, free of charge, by contacting Human Resources. Click here for HHS sample notices [PDF].
- CHIP Notice Most states provide premium assistance subsidies under Medicaid or CHIP to help low-income individuals pay for employer coverage. The CHIP notice explains the subsidies. Employees who are eligible for employer health coverage must be provided with the CHIP notice annually if the employer maintains a group health plan in a state that provides premium assistance subsidies under Medicaid or CHIP. The CHIP notice is updated twice a year, and before distributing the notice, employers should check the DOL website for any revisions. Click here for DOL sample notice [DOC].
- ACA Section 1557 Nondiscrimination Notice Self-funded employer group health plans that are subject to the nondiscrimination requirements of Section 1557 of the ACA (typically, health care providers) must include a nondiscrimination notice and taglines in 15 foreign languages in significant communications and publications, such as annual open enrollment materials and SPDs. Click here for HHS Translated Resources for Covered Entities.
- If the employer offers a wellness program that is subject to the HIPAA/ACA wellness program rules and/or the ADA/GINA wellness program rules, there are participant notice requirements which must be satisfied annually, as well as when the wellness program is first rolled out. Click here for the ADA model notice. Click here for the DOL model disclosure [PDF].