EMPLOVA BLOG

Health Insurance Notices Checklist

The Employee Retirement Income Security Act (ERISA), its many amendments (including COBRA and HIPAA), and the Patient Protection and Affordable Care Act (PPACA) contain numerous employee and plan participant notice requirements. The below list contains many of the basic federal notice requirements that nearly always apply to employers sponsoring health plans. It is important to note that this list is not intended to be all-inclusive, and there are numerous other notices required under special circumstances and by state law.

 1) Summary Plan Description (SPD)

  • Party Responsible: Employer must create and distribute
  • Timing Requirements: Automatically to participants within 90 days of becoming covered by the health plan. Updated SPD must be furnished every 5 years if changes made to SPD information or plan is amended. Otherwise must be furnished every 10 years.

 2) Summary of Material Modifications (SMM)

  • Party Responsible: Employer must create and distribute
  • Timing Requirements: Automatically to participants not later than 210 days after the end of the plan year in which the change is adopted.

 3) Summary Annual Report (SAR)

  • Party Responsible: Employer must create and distribute
  • Timing Requirements: Automatically to participants within 9 months after end of plan year, or 2 months after due date for filing Form 5500 (with approved extension).

 4) Explanation of Benefits (EOB)

  • Party Responsible: Carrier, unless self-insured
  • Timing Requirements: Requirements vary depending on type of plan and type of benefit claim involved.

5) Official Plan Document

  • Party Responsible: Employer must create and distribute
  • Timing Requirements: Copies must be furnished no later than 30 days after a written request.

6) Special Enrollment Rights Notices

  • Party Responsible: Employer must create and distribute
  • Timing Requirements: At or before the time an employee is initially offered the opportunity to enroll in the group health plan.

7) Women’s Health and Cancer Rights Act (WHCRA) Notice

  • Party Responsible: Carrier or Employer – both parties share responsibility for this notice
  • Timing Requirements: Notice must be furnished upon enrollment and annually.

8) Notice of Patient Protections

  • Party Responsible: Employer must create and distribute
  • Timing Requirements: Same as SPD. Usually this verbiage is included in the SPD.

9) Notice of Creditable/Non-Creditable Prescription Drug Coverage

  • Party Responsible: Employer must create and distribute
  • Timing Requirements: On, or before, 10/15 each year.

11) Children’s Health Insurance Program (CHIP) Notice

  • Party Responsible: Employer must create and distribute – only required in certain states
  • Timing Requirements: Annually before the start of each plan year.

12) Mental Health Parity and Addiction Equity Act (MHPAEA) Notice

  • Party Responsible: Health Insurance Carrier (unless self-insured)
  • Timing Requirements: Annually if the group health plan is claiming the increased cost exemption.

13) Newborns’ and Mothers’ Health Protection Act (NMHPA) Notice

  • Party Responsible: Employer – usually verbiage in this regard is included in SPD
  • Timing Requirements: Same as SPD. Usually this verbiage is included in the SPD.

14) COBRA Initial Notice

  • Party Responsible: Employer must create and distribute
  • Timing Requirements: When group health plan coverage commences.

15) COBRA Notice and Election Form

  • Party Responsible: Employer must create and distribute
  • Timing Requirements: Within 44 days of the COBRA qualifying event. If outsourcing COBRA, the employer has 30 days to notify 3rd party and 3rd party has 14 days to provide the notice.

16) Summary of Benefits and Coverage

  • Party Responsible: Carrier must create one for each plan it offers, employer must distribute one for each plan it offers
  • Timing Requirements: To all health-insurance eligible participants and beneficiaries during open enrollment each year and to newly eligible participants and beneficiaries during the plan year.

16) Exchange Notice

  • Party Responsible: Employer must complete standard template
  • Timing Requirements: To all new employees within 14 days of hire date.

16) HIPAA Notice of Privacy Practices

  • Party Responsible: Carrier, unless self-insured
  • Timing Requirements: The insurer must provide the Notice of Privacy Practices when a participant enrolls, upon request and within 60 days of a material revision to the notice. At least once every three years, participants must be notified about the availability of the Notice of Privacy Practices.

16) 1095-C

  • Party Responsible: Employer must complete and distribute
  • Timing Requirements: Annually, on or before 1/31.

 

*Information in this article is general in nature and not intended to replace legal advice in any particular manner. 

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