Annual Open Enrollment - Employee Notices
Employers of all sizes sponsoring group health plans are responsible for providing certain notifications to employees during open enrollment. Listed below are notices that are required to be distributed annually, many employers chose to send these out during their Annual Open Enrollment in order to satisfy that requirement.
Summary of Benefits and Coverages
Who: The health insurance issuer (carrier) must provide an SBC to a group health plan (employer) when the policy is renewed or reissued. The regulations do not specify if the carrier or the employer is responsible for providing the SBC to participants and beneficiaries. It is recommended that employers send this information to plan participants and beneficiaries.
Why: The Affordable Care Act (ACA) requires health plans and issuers to provide a Summary of Benefits and Coverage (SBC) to applicants and enrollees, free of charge. The SBC must follow strict standardized formatting requirements to provide clear, consistent and comparable information about medical plan benefits and coverage.
Medicare Part D Notice
Who: Employers that provide drug coverage to Medicare Part D eligible individuals must determine whether its drug coverage is at least as good (creditable) as the standard health benefit under Medicare Part D.
Why: Individuals who do not receive timely and accurate notification of the plan’s creditable coverage status may incur a late enrollment penalty when applying for Medicare Part D.
Employer CHIP Notice
Who: An employer is subject to the CHIP notice requirement if its group health plan covers participants who reside in a state that provides a premium assistance subsidy, regardless of the employer’s location or principal place of business. The CHIP notice must inform each employee, regardless of enrollment status, of potential opportunities for premium assistance in the state in which the employee resides. Employers are not required to provide the CHIP notice to employees who reside in states that do not offer a premium assistance subsidy.
Why: The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) permits states to offer eligible low-income children and their families a premium assistance subsidy to help pay for employer-sponsored group health coverage.
Women’s Health and Cancer Rights Act
Who: ERISA group health plans, state and local government plans and church plans must provide notices about the WHCRA’s coverage requirements to plan participants at the time of initial enrollment and on an annual basis after initial enrollment.
Why: The Women’s Health and Cancer Rights Act (WHCRA) requires group health plans and health insurance issuers that provide medical and surgical benefits for mastectomies to also provide benefits for reconstructive surgery. This coverage must include: All stages of reconstruction of the breast on which a mastectomy has been performed; Surgery and reconstruction of the other breast to produce a symmetrical appearance; and Prostheses and physical complications of mastectomy, including lymphedemas.
HIPAA Notice of Privacy Practices
Who: Employers that offer self-insured plans must maintain and provide their own Privacy Notices. For employers that offer fully-insured plans, the insurance carrier has primary responsibility for the Privacy Notices. However, if an employer offers a fully-insured plan, but still has access to PHI for plan administrative functions, they must still maintain a Privacy Notice and provide it upon request.
Why: The HIPAA Privacy Rule establishes limits on how covered entities may use and disclose protected health information (PHI) and creates rights for individuals with respect to their own PHI. The HIPAA Privacy Rule requires covered entities to provide a Notice of Privacy Practices to each individual that is the subject of PHI.
HIPAA Notice of Special Enrollment Rights
Who: Employers that offer any of the following group benefit plans: medical, dental and vision benefits, and plans that qualify as “excepted benefits” do not have to offer a special enrollment period.
Why: The Health Insurance Portability and Accountability Act (HIPAA) provides rights and protections for participants and beneficiaries in group health plans. HIPAA includes protections for coverage under group health plans that allow a special opportunity to enroll in a new plan to individuals in certain circumstances.
Uniformed Services Employment & Reemployment Rights Act (USERRA)
Who: USERRA applies to all employers, regardless of size. All employee’s must be notified of their rights, benefits and obligations under USERRA.
Why: The Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) offers certain protections regarding any aspect of employment and prohibits discrimination against individuals based on their membership in the uniformed services.
Employer Wellness Programs
Who: Employers with health-contingent wellness programs or wellness plans that collect health information or involve medical examinations. An employer may have the wellness program provider give out the notice, but the employer is still responsible for ensuring that employees receive the notice.
Why: The Americans with Disabilities Act (ADA) rules state that employers may not require employees to participate in a wellness program; may not deny or limit their health coverage for non-participation; may not retaliate against or interfere with any employee who does not want to participate; and may not coerce, threaten, intimidate or harass anyone into participating.
There are also limited financial and other incentives permitted as part of the voluntary wellness programs under the law. Employees also must receive a notice describing what information will be collected as part of the wellness program, who will receive it, how it will be used, and how it will be kept confidential. If the wellness program provides the notice, the employer must still ensure that their employees receive it.
Electronic delivery of these notices is permissible if the health plan or issuer meets the Department of Labor’s (DOL) rules for electronic disclosure of ERISA-required documents.
Nichole Sehon
Compliance Solutions Manager