Participants must be provided with various notices in connection with an employer’s group health plan.  The notices are required at certain intervals including initially, upon annual open enrollment and at termination.

Notices with Initial Enrollment Materials

  • Notice of Exchange Availability. This notice must contain certain basic information about the employer’s group health coverage so the employee can share that information with the exchange in the event the individual applies to enroll in exchange coverage and seeks a premium tax credit. The notice must be provided to new hires within 14 days of their start date.  DOL’s Sample Notice
  • HIPAA Notice of Special Enrollment Rights. The purpose of this notice is to explain that if the employee previously waived group health coverage, the employee will have the right to enroll in the group health plan in a special enrollment period (outside of the open enrollment period) in the following circumstances: (1) loss of coverage under a group health plan or other health insurance coverage, (2) becoming a new dependent through marriage, birth, or adoption, or (3) losing eligibility for Medicaid or CHIP premium assistance subsidy. DOL’s Sample Notice
  • Summary of Benefits and Coverage. The SBC is intended to provide information in a prescribed format to employees so they can easily compare the information to other plans which they may be eligible for, including coverage on the exchange. A template SBC is available on the DOL website.  The template has been recently revised and is now shorter and includes a new example.  If an employer offers multiple medical plan options, the SBC for each option must be furnished to a new employee as part of the initial enrollment process.  DOL’s SBC Template & Instructions
  • Notice of Grandfathered Status. Plans that were in effect prior to the enactment of the Afordable Care Act (ACA) in 2010 are exempt from some of the insurance market reforms as long as they retain “grandfathered plan” status (that is, are not significantly changed). One of the requirements to retain grandfathered status is to provide notice of grandfathered status in enrollment materials and SPDs.  DOL’s Sample Notice
  • Nondiscrimination Notice. Certain self-funded group health plans and health programs or activities that receive federal financial assistance are subject to the nondiscrimination requirements of Section 1557 of the ACA. Those entities who are subject to Section 1557 must include a nondiscrimination statement and taglines in 15 foreign languages in essential communications and publications, such as enrollment materials and SPDs. HHS’s Sample Notice

Notices Following Initial Enrollment

  • Summary plan description (SPD).
  • Initial Notice of COBRA Rights. This needs to be provided not only to the employee but also to the spouse (if enrolled). As a result, it is typically provided separately from the SPD (which must only be provided to enrolling employees).  DOL’s Sample Notice
  • Women’s Health and Cancer Rights Act. This is a summary of the health plan’s coverage for mastectomies and breast reconstructive services. If the SPD includes this information it does not need to be furnished separately upon initial enrollment (but must be furnished annually – see below).  DOL’s Sample Notice
  • Medicare Part D Notice of Creditable or Non-Creditable Coverage. Newly enrolling employees must be furnished with a copy of this notice upon initial enrollment. CMS’ Model Notices
  • HIPAA Notice of Privacy Practices. The plan’s participant notice of privacy practices must be furnished to newly enrolling employees upon initial enrollment. For fully insured health benefits, the insurer will furnish the notice.  For self-funded health benefits (including HRAs and medical FSAs) the employer/plan sponsor is responsible to issue the notice.  HHS’ Model Notices
  • 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.  For employees living in one of these states, the CHIP notice must be provided upon initial enrollment.  The CHIP notice is updated twice per year and before distributing the notice, the employer should check the DOL website for any revisions.  DOL’s Sample Notice

Annual Notices

Notice Which Applies Every 3 Years

  • HIPAA Notice of Privacy Practices. Once every three years the HIPAA notice of privacy practices must be reissued to enrolled employees or they must be notified of their right to obtain a new copy. Alternatively, the employer may want to consider including a statement in the health plan annual enrollment materials which notifies employees that the employer maintains a HIPAA notice of privacy practices and participants may obtain a new copy at any time and free of charge by contacting human resources.  HHS’ Model Notices

Notices By Each January 31

  • W-2. For employers furnishing at least 250 W-2s, information concerning the cost of the employer’s health coverage (box 12, Code DD).
  • 1095-C. For employers with at least 50 full-time employees and full-time employee equivalents, Form 1095-C informing each full-time employee of his or her offer and cost of group health coverage under the ACA. (Delayed in 2018 to March 2nd.)

Notice Within 9 Months After The Plan Year Ends

  • Summary Annual Report (SAR).

Notices Upon Termination

  • COBRA notice and election form. DOL’s Sample Notice
  • Notice of conversion privilege. (For fully-insured benefits such as group term life insurance.)

Contact VCG’s Vantage for additional information.