Required Notices for Group Health Plans

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Aug 9th, 2010

I apologize in advance. This post is rather dry, but it contains extremely important information. Below are the federally mandated notices you must provide employees participating in your group health plan. Even if you have a Third Party Administrator (TPA), you are not excused from knowing this information.

The Society for Human Resource Management (SHRM) recommends that you take advantage of your 2010 open enrollment to draw extra attention to these required notices. With the recent passage of the Patient Protection and Affordable Care Act, also known as “Obamacare”, revisions to your summary plan description (SPD) and communication documents are likely.

Make lemonade and seize the day by conducting an intensive audit of your plan documents to ensure they reflect the current law accurately. Dare to make benefit information interesting to employees! Bonus points are awarded to the company with the least amount of SPDs in the waste basket after open enrollment.

Notice of special HIPAA enrollment rights must be provided at or before the time an employee is initially offered the opportunity to enroll in a group health plan. This notice must include the new CHIPRA special enrollment rights.

Notice of special CHIPRA enrollment rights for eligible employees and dependents to enroll in employer group health plans must be provided annually (and can be combined with notice of special HIPAA enrollment rights). The U.S. Department of Labor recently published a model notice that can be used to satisfy this requirement and can be found at www.dol.gov/ebsa/chipmodelnotice.doc.

Notice of enrollment opportunity attributable to extension of coverage to adult children up to age 26 must be provided no later than the first day of the first plan year beginning after Sept. 23, 2010, and the adult child must be given 30 days to enroll.

Notice of HIPAA pre-existing condition exclusions, if applicable to the group health plan, must be given to participants prior to enrollment or prior to the date the group health plan imposes a pre-existing condition exclusion.

Notice of HIPAA privacy rights (updated for GINA) must be provided to new enrollees and to other participants at least once every three years by the plan administrator if the group health plan is self-funded, or by the insurer if the plan is fully insured.

Notice of Women’s Health and Cancer Rights Act rights must be given to participants upon enrollment and annually thereafter.

A statement of state and federal law regarding minimum length of stays for mothers and newborns, as required by the Newborns’ and Mothers’ Health Protection Act, must be included in the plan’s SPD.

Notice of creditable/non-creditable prescription drug coverage must be given to Medicare Part D eligible individuals annually prior to eligible individuals’ annual coordinated election period, prior to enrollment in the group health plan, and prior to the date prescription drug coverage ceases.

COBRA notice to new enrollees must be provided to all covered individuals. This notice should be addressed and sent to the most recent address for the employee and spouse and should not be included in open enrollment materials.

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