Open enrollment is an opportunity for employers to meet some of their health plan notice compliance obligations, especially those that need to be provided annually.
These documents need to be distributed and provided to employees (and their dependents) in compliance with various federal laws, such as ERISA, COBRA, HIPAA, and PPACA. Failing to comply can lead to costly penalties.
Although yearly distribution may not be required for some federally mandated health plan notices, employers should consider including some of them with their enrollment materials. Below are some notable notices employers may wish to include.
Summary of Benefits and Coverage (SBC)
A concise document that will detail in plain language, simple and consistent information about health plan benefits and coverage. It acts as a uniform tool that will allow comparison with different coverage options. SBCs must be distributed to participants and beneficiaries upon initial enrollment, annual enrollment, special enrollment, and upon request.
HIPAA Special Enrollment Notice
This notice provides information about expanded open enrollment opportunities for group health plans under certain circumstances. It should be provided to each eligible employee at or before the time the employee is initially offered the opportunity to enroll in the group health plan.
HIPAA Privacy Notice
Group health plans that meet “covered entity” requirement must provide notice of current privacy practices regarding protected personal health information (PHI) to enrolled participants. It should be provided to newly enrolled participants upon enrollment.
Health Insurance Exchange/Marketplace Notice
Employers subject to the Fair Labor Standards Act are generally required to provide all new hires and current employees with a written notice about availability of health coverage and potential tax credit assistance through the public Exchanges. The Exchange Notice must be provided to all new hires within 14 days of hire.
State Premium Assistance Notice for Medicaid and CHIP
Required in states that provide Medicaid or CHIP assistance in the form of premium assistance subsidies and informs employees about potential opportunities for group health plan premiums assistance. It must be provided to all employees, annually, regardless of plan enrollment status.
General Notice of COBRA Rights
Employers who have 20 or more employees and sponsor group health plans must provide participants, and their covered spouses, information about their COBRA rights and obligations generally. It must be provided within 90 days after commencement of plan coverage.
Medicare Part D Creditable (or Non-Creditable) Coverage Notice
Employers providing group health plans that include prescription drug coverage, must provide notice to Medicare eligible individuals before the Medicare Part D annual coordinated election period and any time there is a change that will affect the coverages as creditable or non-creditable. The annual coordinate election period for Medicare Part D begins on October 15 each year.
Grandfathered Plan Status
Group health plans in existence on March 23, 2010 are excused from some health care reform requirements under the Affordable Care Act (ACA) so long as certain changes are not made and appropriate disclosures are made. This notice must be provided when a summary plan description or other similar description of plan benefits is provided to a participant or beneficiary.
Newborns’ and Mothers’ Health Protection Act Notice
If a group health plan provides maternity or newborn infant coverage, the notice must be provided when a summary plan description or other similar description of plan benefits is provided to a participant or beneficiary.
Women’s Health and Cancer Rights Act (WHCRA) Notice
Group health plans that provide medical and surgical benefits for a mastectomy need to provide this notice describing these benefits and information on how the coverage will work. It must be provided upon enrollment and annually.
OneDigital’s Employer Notice Package provides greater detail on these federal notices, as well as others, including links to template language.
For questions about the federal notices, reach out to your OneDigital consultant today.