Annual Revision


DEADLINE

Children’s Health Insurance Program (CHIP)
Model Notice (Sp) | Electronic Distribution: DOL Safe Harbor
See the CHIPRA compliance activity for more information.
Distribution Requirements: Distribute the notice annually to all employees who who reside in a state providing a premium assistance subsidy under Medicaid or CHIP, not just those who are eligible or enrolled in the health plan. Because this criteria may be hard to determine, many employers take the cautious approach and provide the notice to all employees.

 

Medicare Part D Creditable Coverage Notice
Model Notice (Sp) | Electronic Version: See: Footnote 1
See the Medicare Part D compliance activity for more information.
Distribution Requirements: The notice must be provided annually on or before October 15th of each year.
Other Disclosure Requirements: The notice must also be provided upon enrollment and following changes in creditable coverage status.

 

Women’s Health and Cancer Rights Act (WHCRA)
Model Notice (Sp) | Electronic Version: See: DOL Safe Harbor
See the Women’s Health Act compliance activity for more information.
Distribution Requirements: Distribute the notice annually to plan participants at any time during the plan year.
Other Disclosure Requirements: In addition to the annual notice, disclosure of a woman’s rights relative to WHCRA must be provided upon enrollment.

 

Summary of Benefits and Coverage (SBC)
Model Notice | Distribute Electronically: See Footnote2
See the SBC: Fully Insured Plans compliance activity for more information.
Distribution Requirements: The insurer is jointly responsible with the plan administrator (typically the employer) for furnishing the SBC to participants and beneficiaries. In addition to when an individual first becomes eligible for the plan, an SBC must be provided at each renewal. If a plan or issuer requires participants and beneficiaries to actively elect to maintain coverage during an open enrollment, or provides them with the opportunity to change coverage options in an open enrollment, the plan or issuer must provide the SBC at the same time it distributes open enrollment materials. If there is no requirement to elect to renew, and no opportunity to change coverage options, renewal is considered to be automatic and the SBC must be provided no later than 30 days prior to the first day of the new plan or policy year.
Other Disclosure Requirements: The SBC must be provided upon requestio and when an individual becomes eligible for the plan, including through special enrollment.

 

Footnotes:

[1] Electronic distribution is allowed via the DOL Safe Harbor, but the CMS prefers using paper documents because Part D eligible individuals are more likely to receive and understand them.

[2] The SBC safe harbor allows the SBC to be provided electronically to participants and beneficiaries in connection with their online enrollment or renewal of coverage. If online enrollment is not available, the SBC may be provided electronically according to the DOL safe harbor for participants covered under the plan. For participants and beneficiaries who are eligible but not enrolled, the SBC may be provided electronically if the format is readily accessible, which includes an Internet posting if the individuals are notified in paper form (such as a postcard) or via email that the documents are available on the Internet. Special rules may apply for non-federal governmental plans.