Notices and Disclosures: Annual


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These notices and disclosures should be provided to employees on an annual basis. Generally, the notices can be provided at any time during the plan year unless specified below.

Note: If an employee becomes eligible for the plan after the distribution of an annual notice, the employee should be given the notice on or before enrollment in the plan.

ALL PLANS

Children’s Health Insurance Program (CHIP) Distribute Electronically: See DOL Safe Harbor
The Children’s Health Insurance Program Reauthorization Act (CHIPRA) requires plans to disclose certain special enrollment opportunities to participants or beneficiaries (employees, dependents, COBRA qualified beneficiaries, etc.) residing in states that provide a premium assistance subsidy under Medicaid or CHIP. Because an employer may not always be aware of what states provide this assistance and where all employees and their beneficiaries reside, many employers take the cautious approach and provide the notice to all employees.
Distribution Requirements: Distribute the notice annually to all employees who meet the criteria described above, not just those who are eligible or enrolled in the health plan.

 

Medicare Part D Creditable Coverage Notice Distribute Electronically: See Footnote 1
Plans must notify Medicare Part D eligible participants of whether the current employer-sponsored prescription drug benefit provides creditable coverage. Because an employer may not always be aware of which employee participants and their beneficiaries are (or will be) eligible for Medicare Part D, many employers take the cautious approach and provide the notice to all employees.
Distribution Requirements: The notice must be provided annually to all employees who meet the criteria described above 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) Distribute Electronically: See DOL Safe Harbor
Group health plans that provide coverage for medical and surgical benefits with respect to mastectomies must disclose a woman’s rights after a mastectomy. Plans sponsored by self-funded, nonfederal governmental employers may elect to opt-out of this provision, which would require that an “opt-out notice” be provided at enrollment.
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.

 

SELF-INSURED PLANS

Summary of Benefits and Coverage (SBC) Distribute Electronically: See Footnote 2
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 also be provided as part of any written application materials. In addition, the SBC must be provided upon request and when an individual becomes eligible for the plan, including through special enrollment. A Notice of Material Modification or a new SBC must be provided when there is a change during the plan year that would affect the content of the SBC.

 

FULLY INSURED PLANS

Summary of Benefits and Coverage (SBC) Distribute Electronically: See Footnote 2
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 also be provided as part of any written application materials. In addition, the SBC must be provided upon request and when an individual becomes eligible for the plan, including through special enrollment. A Notice of Material Modification or a new SBC must be provided when there is a change during the plan year that would affect the content of the SBC.

 

PLANS THAT FILE A FORM 5500 (EXCLUDING LARGE, UNFUNDED PLANS)

Summary Annual Report (SAR) Distribute Electronically: See DOL Safe Harbor
The plan must provide to employee participants a narrative summary of the financial information contained on the Form 5500. See the SAR reference material for information on which plans are exempt from this requirement.
Distribution Requirements: Distribute to employees participating in the plan within 9 months of the close of the plan year or 2 months after the due date for filing the Form 5500.

 

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.
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[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.
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