Brief summary of all the notice requirements to participants in group health plans.

 

The information below might be of some use to our broker community as we head closer to 2015. This information was excerpted from an article and hopefully it might help you better serve your employer groups.

It is a brief summary of all the notice requirements to participants in group health plans.

 

Women’s Health and Cancer Rights Act (“WHCRA”)
Each year participants must receive a summary plan description (SPD) of a health plan’s coverage for mastectomies and breast reconstructive services. If the SPD is reissued each year, the notice can be included in the SPD. Otherwise, a separate notice should be included in the plan’s annual enrollment materials.

Medicare Part D Notice of Creditable or Non-Creditable Coverage 
This annual notice must be provided to any participant (employee or dependent) who has coverage under Medicare Part A or coverage under Medicare Part B and who lives in the service area of a Medicare Part D prescription drug plan. While employers usually know whether an employee is eligible for Medicare, employers often do not have this information regarding dependents. As a result, providing the notice to all participants ensures compliance. Notice should be provided by October 15. Again, if the SPD is reissued each year, the notice can be included in the SPD. Otherwise, a separate notice should be included in the plan’s annual enrollment materials.

HIPAA Notice of Privacy Practices
Participants must be notified at least once every three years that they may receive a 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. Further, the notice should have been updated for the 2013 HHS regulations regarding HITECH. Specifically, the notice must include an explanation of a covered entity’s obligation to notify affected individuals following the breach of unsecured protected health information.

Children’s Health Insurance Program Reauthorization Act (“CHIPRA”)
Since 2009, special enrollment rights to immediately enroll in an employer’s health plan arise if an individual becomes eligible for a state premium assistance subsidy under Medicaid or CHIP. The subsidy helps low income individuals pay for employer coverage, transferring them from government-sponsored health programs to employer health plans. While most states offer premium assistance subsidies, Michigan is one of the few which does not. CHIPRA imposes a notice requirement on employers who maintain health plans with participants residing in one or more states providing a premium assistance subsidy. The notice must be provided annually to all employees residing in each premium assistance subsidy state, including employees not enrolled in the plan. Model notice language, which is periodically updated, is available on the DOL website and includes contact information for each state offering a premium assistance subsidy. If you have participants living outside of Michigan, you may be required to comply with this notice obligation. Before distributing the notice each year you should check the DOL website for any updates to the model.

Summary of Benefits and Coverage 
Health Care Reform added a new participant notice requirement known as the Summary of Benefits and Coverage (“SBC”). The purpose of the SBC is to provide certain information in a prescribed format to participants in an employer’s medical plan so they can easily compare the information to other plans which they may be eligible for, including the coverages which will be offered on the Health Insurance Marketplaces. In addition, beginning with the 2014 plan year, the SBC must indicate if the plan constitutes “minimum essential coverage” and whether the plan provides “minimum value.” The notice should be provided annually to participants, as well as in other prescribed circumstances.

Notice of Exchange Availability
By no later than October 1, 2013 employers were required to issue employees a Notice of Exchange Availability. The notice provided certain basic information about the employer’s group health coverage so the employee could share that information with the Health Insurance Marketplace in the event the individual applied to enroll in exchange coverage and obtain a premium credit. The notice was a one-time requirement to existing employees and is not required to be reissued annually. However, any new hires after October 1, 2013, should be provided a copy of the notice within 14 days of their start date.

Notice Regarding Grandfathered Plan Status
Plans that were in effect prior to the enactment of Health Care Reform are exempt from some of the insurance market reforms under Health Care Reform so long as they retain “grandfathered plan” status. One of the requirements to retain grandfathered plan status is including certain disclosures in SPDs and other plan materials (such as annual open enrollment materials) provided to participants describing the plan’s benefits. The disclosure must state that the plan is grandfathered and must provide contact information for questions and complaints. Model notice language is available on the DOL website.