These notices and disclosures are typically provided to employee participants and/or beneficiaries when they enroll in the plan. They are often included in the Summary Plan Description (SPD) (please note that the SPD has its own distribution requirements 1). If not included in the SPD, they should be provided as a separate notice or as part of other plans materials (if applicable).
The summary below indicates whether each notice and disclosure should also be included in Enrollment Materials or the Summary of Benefits and Coverage (SBC).
ALL PLANS
Newborn’s and Mother’s Health Protection Act (NMHPA)
Enrollment Material: SBC:
Group health plans subject to HIPAA must disclose a mother’s and newborn’s rights after childbirth. Plans sponsored by self-funded, nonfederal governmental employers may elect to opt-out of this provision.
Electronic Distribution: Email and other Internet-based methods that comply with the DOL safe harbor can be used.
Women’s Health and Cancer Rights Act (WHCRA)
Enrollment Material: SBC:
Group health plans subject to HIPAA 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.
Electronic Distribution: Email and other Internet-based methods that comply with the DOL safe harbor can be used.
Other Disclosure Requirements: In addition to disclosure in the SPD, participants must be given an annual notice.
Special Enrollment Rights
Enrollment Material: SBC:
The Special Enrollment Rights disclosure explains important information about the participants’ and beneficiaries’ right to benefits and when that right may be lost.
Electronic Distribution: Email and other Internet-based methods that comply with the DOL safe harbor can be used.
Other Disclosure Requirements: In addition to disclosure in the SPD, group health plans must provide a notice to eligible enrollees of their HIPAA special enrollment rights on or before the date the individuals are offered the opportunity to enroll in the plan. This is often included in enrollment materials.
Qualified Medical Child Support Order (QMCSO)
Enrollment Material: SBC:
The plan must disclose its procedures for determining whether a Medical Child Support Order is qualified (QMCSO) or a statement indicating how a participant may obtain a copy of the procedures. A National Medical Support Notice (NMSN) might also be considered a QMCSO.
Electronic Distribution: Electronic distribution is allowed, but not recommended due to the consent and notice requirements for individuals who do not have access to an employer’s system (such as alternate recipients). Privacy issues are also a concern with electronic distribution.
Other Disclosure Requirements: After receiving a medical child support order, plans must respond with letters to the participant and alternate recipients notifying them of the receipt of a medical support order and whether an order has been determined to be a QMCSO.
Prior to enrollment, plans must notify Medicare Part D eligible participants of whether the employer sponsored prescription drug benefit provides creditable coverage. The notices should indicate whether coverage is creditable for the upcoming plan year. 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.
Electronic Distribution: Electronic distribution is allowed, but CMS prefers using paper documents because Part D eligible individuals are more likely to receive and understand them.
Other Disclosure Requirements: The notices must also be provided on or before October 15 of each year and following changes in creditable coverage status.
Uniformed Services Employment and Reemployment Act (USERRA)
Enrollment Material: SBC:
The plan must disclose information on eligibility for group health plan benefits during a leave taken under USERRA and restoration of benefits upon return from USERRA leave.
Electronic Distribution: Email and other Internet-based methods that comply with the DOL safe harbor can be used.
Other Disclosure Requirements: This requirement is often met by placing a notice or poster (where other employee notices are customarily placed) that describes an employee’s rights under USERRA. A continuation notice form may be required after the employer learns that an employee has been called to duty (this is often combined with the COBRA Election Notice-if applicable).
The plan administrator must disclose COBRA rights to participants AND covered spouses. The SPD should include COBRA continuation of coverage rights and requirements. If COBRA administration is outsourced, an employer should determine whether it (as the plan administrator) or the COBRA Administrator is responsible for distributing COBRA notices.
Electronic Distribution: Electronic distribution is allowed, but not recommended due to the consent and notice requirements for individuals who do not have access to an employer’s system (such as covered spouses).
Other Disclosure Requirements: Because the plan must disclose COBRA rights to participants AND covered spouses, the COBRA Initial Notice is often mailed to the employee participant’s home address. Additional notices are required when a participant or beneficiary experiences a qualifying event.
A covered entity must provide to individuals a notice of the plan’s privacy practices upon enrollment in the plan. The covered entity may include the privacy notice with other written materials that are mailed to the individuals (except that the notice may not be combined in a single document with an authorization).
Electronic Distribution: Email and other Internet-based methods that comply with the DOL safe harbor can be used.
Other Disclosure Requirements: If the covered entity maintains a website that contains information about the covered entity’s customer services or benefits, the covered entity must post its notice of privacy practices on the website and must make the notice available electronically through the website. A new privacy notice must be provided after a material change to the notice and the plan must notify participants at least once every three years that a notice of privacy practices is available.
All group health plans claiming “grandfathered status” under the ACA must disclose this in all plan materials distributed to participants describing benefits under the plan. A Non-Grandfathered plan does not have to disclose its status.
Other Disclosure Requirements: A plan’s grandfathered status should also be disclosed in the SBC. In addition, it should be included in any materials, including enrollment materials that describe benefits under the plan.
NON-GRANDFATHERED PLANS THAT REQUIRE DESIGNATION OF A PCP
Patient Protections
Enrollment Material: SBC:
Non-Grandfathered plans that require the designation of a primary care provider (PCP) must provide information relative to a participant’s rights under the ACA. The plan’s SPD should describe a participant’s rights when choosing a PCP.
Other Disclosure Requirements: A participant’s rights under the ACA relative to selection of a PCP should also be disclosed in the SBC. In addition, it should be included in any materials, including enrollment materials that describe benefits under the plan.
PLANS WITH WELLNESS PROGRAMS THAT OFFER A STANDARD-BASED INCENTIVE
The plan must disclose the availability of a wavier or alternative standard to receive a standard-based wellness incentive. If the enrollment materials include information on the standard-based wellness incentive, it should also include information about the availability of a waiver or alternative.
Electronic Distribution: Email and other Internet-based methods that comply with the DOL safe harbor can be used.
Other Disclosure Requirements: A notice of the availability of a waiver or alternative standard must be included in all plan materials, including enrollment materials that describe the standard-based wellness incentive.
PLANS WITH HEALTH PROGRAMS THAT INCLUDE SCREENINGS AND/OR DISABILITY-RELATED QUESTIONS
When a wellness program includes screenings and/or disability-related questions, the employer must provide a notice clearly explaining what medical information will be obtained, how the medical information will be used, who will receive the medical information, the restrictions on its disclosure, and the methods the covered entity uses to prevent improper disclosure of medical information. The proposed rule, published on April 20, 2015, does not provide any details on how or when this notice is to be given.
Electronic Distribution: The proposed rule, published on April 20, 2015, does not provide any details on how or when this notice is to be given.
PLANS THAT ACCEPT DEPENDENTS BEYOND AGE 26 IF FULL-TIME STUDENTS
Michelle’s Law
Enrollment Material: SBC:
The plan must inform students over the age of 26 their right to continued coverage during medically necessary leaves of absence. Currently, no guidance has been provided regarding the form or delivery of the Michelle’s law notice; however, general DOL distribution guidelines require that material be furnished in a way that is reasonably calculated to ensure delivery. In practice, this will not apply to plans that do not exceed the age-26 dependent mandate under the ACA. In addition, plans sponsored by self-funded, nonfederal governmental employers may elect to opt-out of this provision.
Electronic Distribution: Currently, no guidance has been provided regarding the form or delivery of the Michelle’s law notice. Presumably, email and other Internet-based methods that comply with the DOL safe harbor may be used.
Footnotes:
[1] The Summary Plan Description (SPD) must be provided to participants within 90 days of coverage. An updated SPD must be furnished every 5 years if the plan is amended or every 10 years if it is not. A notice or new SPD must be provided when there is a material change to the plan. Email and other Internet-based methods that comply with the DOL safe harbor can be used to distribute the SPD automatically.
[2] The Medicare Part D Creditable Coverage Notice must be provided to Part D eligible individuals prior to enrollment in a group health plan. The notice can be included in the SPD, with other plan materials or with enrollment materials as long as the distribution requirements are met.
[3] The Initial (General) Notice must be provided to employees AND spouses upon enrollment in a group health plan. The notice can be included in the SPD, with other plan materials or with enrollment materials as long as the distribution requirements are met.
[4] The HIPAA Notice of Privacy Practices must be provided to participants upon enrollment in a group health plan. The notice can be included in the SPD, with other plan materials or with enrollment materials as long as the distribution requirements are met.
[5] A plan’s “grandfathered status” should be included in any materials, including enrollment materials that describe benefits under the plan.
[6] The availability of a waiver or alternative should be included in any materials, including enrollment materials that include information on the standard-based wellness incentive.
[7] Although further guidance is expected, a plan should presumably disclose how it will use the medical information obtained in any description of its wellness program, including enrollment materials.
Material contained in ComplianceDashboard is a compilation of generally published information by the Department of Labor and other public agencies regulating employee benefit plans and employee benefit issues. It is not legal advice, and should not be construed as legal advice. If legal advice or other professional assistance is or may be required with regard to any issues referenced in this website, the services of a competent legal or tax professional should be immediately sought. The inclusion of links within the ComplianceDashboard website is for informational purposes only. ComplianceDashboard does not warrant the accuracy of information outside this website that is found as a result of following links contained herein, nor does the inclusion of those links herein constitute endorsement of the content of any other website. If you have questions regarding this disclaimer, please contact us at 877-328-7880.
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