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Health and Welfare Plans: Open Enrollment Reminders




by:
Kutak Rock LLP - Omaha Office

 
November 6, 2013

Previously published on November 5, 2013

Autumn means open enrollment season for most employers. Employers should confirm they are providing certain required notices to the proper parties. Some of these notices must be provided annually while others must be provided when an employee first enrolls in the plan. This Client Alert summarizes which notices should be provided and when. NOTE: This Client Alert describes federally mandated notices only —states may have additional notice requirements.

At Open Enrollment. The following notices for group health plans must be provided before or with open enrollment materials. The notices should be provided to eligible employees, not simply those who choose to enroll in the plan.

  • Summary of Benefits and Coverage (does not apply to excepted benefit plans). If there is no open enrollment because renewal is automatic, the SBC must be provided at least 30 days before the first day of the plan year.
  • Special Enrollment Rights (does not apply to excepted benefit plans).

Upon Enrollment. The following notices must be provided to participants when they enroll in a group health plan.

  • COBRA General Notice.
  • HIPAA Notice of Privacy Practices.
  • Notice of Grandfathered Status (if applicable).

Annually. These notices must be provided to participants in group health plans annually. In many cases, the notice is distributed in conjunction with the summary plan description.

  • Patient Protection Disclosures (for plans that require designation of a primary care provider).
  • Women’s Health and Cancer Rights Act (does not apply to excepted benefit plans).
  • Medicare Part-D Creditable Coverage (for plans offering prescription drug coverage).
  • Wellness Program Alternative Standard (for plans that offer a health-contingent wellness plan).
  • HIPAA Opt-Out Notice (for self-funded, non-federal governmental health plans).

Related Disclosures. As an additional friendly reminder, the following documents must be distributed by the due dates indicated.

  • Exchange Notice (for group health plans)—within 14 days of hire.
  • Summary Annual Report (for welfare plans that are required to file a Form 5500)—within 9 months of the end of the plan year.
  • Summary Plan Descriptions (for all welfare plans)—within 90 days after enrollment.

NEXT STEPS FOR EMPLOYERS

Employers should not assume that third party administrators or health insurance issuers are providing all of the required notices, at the appropriate times, to eligible employees or participants. Employers whose benefit plans are self-funded should verify they are providing the required notices as described above. If the employer’s benefit plans are insured, the employer should verify which notices are provided by the insurance issuer and identify any gaps.



 

The views expressed in this document are solely the views of the author and not Martindale-Hubbell. This document is intended for informational purposes only and is not legal advice or a substitute for consultation with a licensed legal professional in a particular case or circumstance.
 

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