For many businesses, open enrollment is in full swing so it’s a good time to double check that all required notices have been provided or get an early start on organizing for next year. Businesses that offer group health plans to their employees are required to provide certain notices during open enrollment or at other times in the year. Many employers choose to include all health benefits related notices during open enrollment to simplify administrative tasks and save money.
Required notices to include with 2019 open enrollment
The first step when planning notices is for Human Resources (HR) to review all open enrollment materials to make sure that they have the correct terms and cost of coverage.
Any plan changes from the prior year must be laid out in simple terms in a Summary of Material Modifications (SMM). A SMM notice must be given to all plan participants at least 60 days before the changes will take effect.
A Summary Plan Description (SPD) describes what the plan covers and how it works, how employees can use their benefits once enrolled, how to file a claim and how to appeal denied benefits. For existing health plans, an SPD must be provided to new plan participants within 90 days of their plan coverage starting, making open enrollment a convenient time. For new health plans, the SPD must be provided within 120 days. Note that an SPD must be provided every five years if material modifications have been made in that time or every 10 years if there have been no modifications and within 30 days of request. These rules apply to any organization subject to the Employee Retirement Income Security Act (ERISA) of 1974 (ERISA), which is almost every private-sector employer that offers welfare benefit plans.
The group health plan or the health insurance issuer must also create and provide a Summary of Benefits and Coverage (SBC) and Uniform Glossary to all applicants and enrollees. The SBC is a standardized, 4-page document with a short description of all benefits options written in simple terms so employees can easily compare their options. The Uniform Glossary gives definitions for commonly used health insurance terms like co-insurance.
Group health plans that offer benefits for medical and surgical mastectomies must provide a Women’s Health and Cancer Rights Notice (WHCRA) each year, often included with open enrollment notices.
The Childrens Health Insurance Protection Reauthorization Act (CHIPRA) Notice must be provided at any time of the year by group health plans that cover residents in a state that offers a premium assistance subsidy under a Medicaid plan or CHIP. See ,https://www.benefits.gov/benefit/1255 for information about Hawaii QUEST and Medicaid Fee-For-Service.
All group health plans that include prescription drug coverage as part of their health insurance plan must provide a Medicare Part D Notice of Creditable or Non-Creditable Coverage before October 15 each year. The purpose is to show whether the drug coverage offered by the group health plan is as good or better than the Medicare Part D coverage. While this notice is technically only relevant to employees who qualify for Medicare, employers often send it to all employees.
The COBRA General Notice is required by most employers with 20 or more employees who provide group health benefits. The notice must be provided within 90 days of the start of the health plan coverage, making open enrollment a convenient time.
In order to maintain a group health plan’s grandfathered status, a Grandfathered Plan Notice must be provided. The notice should include a description of the plan’s benefits.
If a non-grandfathered plan requires enrollees to designate a participating primary care provider, the plan or issuer is required to provide a Notice of Patient Protections whenever the SPD or any other formal description of health benefits is given to a plan participant. This notice is usually included with enrollment materials or with the SPD.
The Special Enrollment Rights Notice – HIPPA provides eligible employees with information on the health plan’s special enrollment rules including their right to enroll within 30 days if they lose other coverage or experience one of several Qualifying Life Events (QLEs). The notice – which must be provided at or before the time the employee is first able to enroll in a health plan – also explains that the law prohibits discrimination against employees and their dependents based on any health factors.
A HIPAA Privacy Notice must be maintained and provided by all self-insurance group health plans. This notice should be provided to new enrollees at the time they enroll and at least once every three years.
The Wellness Notice – HIPAA must be provided to enrollees of groups health plans that require a health or wellness element to qualify for a reward or discounted health plan cost. The notice informs employees that there is an alternate way to qualify for the program’s reward and must be included in all plan materials that discuss the terms of the wellness program.
The Wellness Notice – ADA must be provided by group health plans that collect health information or use medical exams as part of their wellness program in order to comply with the Americans with Disabilities Act (ADA). Employees must receive the notice before submitting to a health exam or giving any health information and with enough time to decide whether they want to opt out.
The Availability of Health Insurance Marketplaces Notice must be provided to employees of employers covered by the Fair Labor Standards Act (FLSA). The notice gives employees information about the health insurance marketplace/exchanges of the state(s) in which they live.
This post is meant to give a brief overview of required health benefits notices during open enrollment and is not intended to be a comprehensive list.
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