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Time to Review Health-Related Notices

October 3, 2017
With health-plan open enrollment right around the corner, now is a good time to review the health care –related notices that you must provide to your employees.
 
The notice requirements stem from multiple laws passed at different times seeking to achieve various health-care coverage objectives.  The outline below identifies which documents and notices need to be provided to whom and at what time. 
 
Summary Plan Description (SPD) – A document that details all the elements of your health plan, including eligibility, coverages and complaint procedures.
  • Existing plans must provide a copy of the SPD, or a notice that a copy is available on request, to new plan participants within 90 days of joining the plan.  Beneficiaries must receive notice within 90 days of first receiving benefits.
  • New plans must provide a copy of the SPD, or a notice that a copy is available on request, to plan participants within 120 days of new plan start date.  Beneficiaries must receive notice within 120 days of new plan start date. 
  • All plans must provide a copy of the SPD to any participant or beneficiary within 30 days of a request. 
Summary of Benefits and Coverage (SBC) and Uniform Glossary – A shorter document than the SPD that summarizes key aspects of the health plan.
  • A copy must be provided to all eligible employees during open enrollment period or when there is a Qualifying Life Event (QLE)
Summary of Material Modifications (SMM) - A document that informs plan participants of material changes to the plan.
  • Must be provided to all plan participants at least 60 days prior to the effective date of a "material modifications" to the plan outside the open enrollment period. 
Availability of Health Insurance Marketplaces Notice – An Affordable Care Act (ACA) required notice of the availability of health insurance through state sponsored healthcare marketplaces.
  • Must be provided to all new hires at the time of hire regardless of eligibility.   Massachusetts has a model notice that employers can use which can be found at https://betterhealthconnector.com/wp-content/uploads/MAHC_NoticeExchangeACA_Marketplace_090313.pdf
Children's Health Insurance Program Reauthorization Act (CHIPRA) – A program that provides health insurance assistance to children in certain income levels.
  • All employees residing in states in which CHIRPA premium assistance is available (including Massachusetts), including those not enrolled in a plan, to inform them of the availability of Medicaid and Children’s Health Insurance Program (CHIP) subsidies 
 
Women's Health & Cancer Rights Act of 1998 (WHCRA) Notice – A notice of certain required plan coverages.
  • Must be provided to plan participants annually, usually in open enrollment and new hire packages.
Health Insurance Portability and Accountability Act (HIPAA) Special Enrollment Rights Notice – Notice of rule that requires employer plans to extend special enrollment opportunities to certain employees and dependents if loss of other coverage occurs or new dependents are gained
  • Must be provided to all eligible employees at or before the time they are first offered the opportunity to enroll. 
  • Must be provided to employees within 30 days of qualifying life events.
HIPAA Privacy Notice – A notice to primary enrollees of a self-funded plan in which the employer has access to Protected Health Information (PHI) information that information is protected by the plan.
  • Must be provided to all plan participants at least once every 3 years or upon request from any person covered by the plan.
Consolidated Omnibus Reconciliation Act (COBRA) Notice – A notice to employees of employers with 20 or more employees that they have the right to continue coverage at their own cost after group coverage has terminated for certain reasons.
  • An initial notice of COBRA rights must be provided to plan participants and their spouses within 90 of the start of coverage.
  • An election notice must be provided to the employee, spouse and any dependent within 14 days of loss of coverage
  • An unavailability of continuation of coverage notice stating that the employee, spouse or dependent child is not eligible for continuation of coverage must be provided to each employee, spouse and dependent child within 14 days of a request for coverage.
  • A termination of coverage notice must be provided to anyone receiving coverage through an exercise of COBRA rights when the coverage is terminated prior to the statutory period.
Medicare Part D Creditable (or Non-Creditable) Coverage Notice – A notice to all employees, spouses and dependents eligible for Medicare coverage
  • Must be provided annually by October 15 to all plan participants with access to a Medicare Part D prescription drug plan who have Medicare Part A or Part B.
Please contact the AIM Employer Hotline at 800-470-6277 if you have questions about this or any other HR-related issue.  
 
 
 
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