Notices and Disclosures
Timing:
These notices and disclosures are typically provided to employees on or before the date they are eligible to enroll. Often included in enrollment materials. This requirement may also be satisfied by including the information in the Summary Plan Description ONLY if given to all eligible employees.
Plan Type: Self-Insured Plans
Notice/Disclosure: Summary of Benefits & coverage (SBC)
Requirements: The plan administrator (generally, the employer) is responsibible for creating and furnishing the SBC to participants. The SBC must be provided to all eligible employees on the first date an employee is eligible to enroll.
Electronic Distribution: A safe harbor specifically for SBCs 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.
Other Disclosure Requirements: Unless the plan or issuer has knowledge of a separate address for a beneficiary, the SBC may be provided to the participant on behalf of the beneficiary, including when the SBC is distributed electronically. A notice or new SBC must be provided when there is a change to the SBC during the plan year.
Bywater Distribution Method: Direct to Employer
Notice/Disclosure: Special Enrollment Rights
Requirements: 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.
Electronic Distribution: Email and other Internet-based methods that comply with the DOL safe harbor can be used.
Other Disclosure Requirements: Also include the content of the notice of special enrollment rights in the plan SPD because it explains important information about the participants’ and beneficiaries’ right to benefits and when that right may be lost.
Bywater Distribution Method: SPD
Plan Type: Grandfathered Plans
Notice/Disclosure: Grandfathered Status
Requirements: All group health plans claiming “grandfathered status” under the ACA must disclose this status to participants. The disclosure must be included with any material, including enrollment material, that describes benefits under the plan. Non-Grandfathered plans do not have to disclose their status.
Electronic Distribution: Follow the guidelines for the SBC.
Other Disclosure Requirements: Because the SPD and SBC describe benefits under the plan, a plan must disclose its grandfathered status in both documents.
Bywater Distribution Method: SPD
These notices and disclosures are typically provided to employee participants and/or beneficiaries when they enroll in the health plan. Often included in Summary Plan Description (SPD). the SPD has specific distribution requirements not listed below. Summary Plan Description Distribution Requirements: SPD must be provided to particpants 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 electronically.
Plan Type: Self-Insured Plans
Notice/Disclosure: Newborn's & Mother's Health Protection Act (NMHPA)
Requirements: 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.
Bywater Distribution Method: SPD
Notice/Disclosure: Women's Health & Cancer Rights Act (WHCRA)
Requirements: Group health plans subject to HIPAA must disclose a women’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.
Bywater Distribution Method: SPD
Notice/Disclosure: Special Enrollment Rights
Requirements: 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.
Bywater Distribution Method: SPD
Notice/Disclosure: Qualified Medical Child Support Order (QMCSO)
Requirements: The plan must disclose its procedures for determining whether a Medical Child Support Order is qualified 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.
Bywater Distribution Method: SPD
Notice/Disclosure: Uniformed Services Employment and Reemployment Act
Requirements: 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).
Bywater Distribution Method: SPD
Plan Type: Plans Subject to COBRA
Notice/Disclosure: Initial (General) Notice
Requirements: The plan must disclose COBRA rights to participants and covered spouses. The SPD should include COBRA continuation of coverage rights and requirements.
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 right to participants AND covered spouses, the COBRA General Notice is often also mailed to the participant’s home address. Additional notices are required when a participant or beneficiary experiences a qualifying event.
Bywater Distribution Method: SPD
Plan Type: Grandfathered Plans
Notice/Disclosure: Grandfathered Status
Requirements: 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.
Electronic Distribution: Follow the guidelines for the SBC.
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.
Bywater Distribution Method: SPD
These notices and disclosures are typically provided to employee participants and/or beneficiaries on an annual basis. Generally, the notices can be provided at any time during the year unless specified below. note: If an employee’s employment date occurs after the distribution of an annual notice, the employee should be given the notice upon enrollment.
Plan Type: Self-Insured Plans
Requirements: The Children’s Health Insurance Program Reauthorization Act (CHIPRA) requires plans to notify 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 Requirement: Distribute annually to all employees who meet the criteria described above, not just those who are eligible or enrolled in the health plan.
Electronic Distribution: Email and other Internet-based methods that comply with the DOL safe harbor can be used.
Bywater Distribution Method: Direct to Employer
Notice/Disclosure: Women's Health & Cancer Rights Act (WHCRA)
Requirements: Plans must notify participants of the protections available for individuals who elect breast reconstruction in connection with a mastectomy.
Distribution Requirement: Distribute annually to employees participating in the plan. Please note that there is an additional disclosure required under WHCRA that is typically included in the SPD.
Electronic Distribution: Email and other Internet-based methods that comply with the DOL safe harbor can be used.
Bywater Distribution Method: SPD
Notice/Disclosure: Medicare Creditable Coverage Notice
Requirements: Plans must notify Medicare Part D eligible participants of whether the 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 Requirement: Distribute annually to employee participants who meet the criteria described above. The notices may be provided separately or with other plan participant materials if (1) they are provided prominently with other plan participant information materials that the sponsor is required to provide; (2) they are conspicuous; and (3) they include the content information prescribed by CMS. A separate disclosure notice must be provided if the employer knows that any spouse or dependent who is Part D eligible resides at a different address than where the participant/policy holder materials were mailed. The notices must be provided on or before October 15 of each year and following any changes in creditable coverage status.
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.
Bywater Distribution Method: Direct to Employer
Requirements: Non-Grandfathered plans must provide information relative to a participant’s rights under the ACA to choose a primary care provider. This disclosure should be included in all plan materials distributed to participants describing benefits under the plan, including enrollment materials.
Bywater Distribution Method: Direct to Employer
Plan Type: Plans with access to PHI
Notice/Disclosure: HIPAA Notice of Privacy Practices
Requirements: A covered entity must provide to individuals a notice of the plan’s privacy practices upon enrollment The plan must notify individuals then covered by the plan of the availability of and how to obtain the notice at least once every three years after the last distribution or notification.
Distribution Requirement: 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). In addition to distributing the notice, 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.
Electronic Distribution: Email and other Internet-based methods that comply with the DOL safe harbor can be used.
Bywater Distribution Method: SPD
These notices and disclosures are typically provided to employee participants and/or beneficiaries upon the occurrence of certain events.
Plan Type: Self-Insured Plans
Requirements: Employers subject to the Fair Labor Standards Act must provide notice to employees of their coverage options, including options available in the Health Insurance Marketplace.
Distribution Requirement: Distribute to all full-time and part-time employees, regardless of plan enrollment status, within 14 days of an employee’s start date.
Electronic Distribution: Email and other Internet-based methods that comply with the DOL safe harbor can be used.
Bywater Distribution Method: Direct to Employer
Notice/Disclosure: Summary of Material Modifications
Requirements: A plan must provide written notice to participants if there is a material modification during the plan or policy year that would affect the content of material required to be included in the SPD. Please note: if the material modification affects the SBC, providing the Notice of Mofications to SBC will also satisfy this notice requirement.
Distribution Requirement: Provide to participants no later than 210 days after the end of the plan year in which the change was adopted. If the change was a material reduction in benefits or services, provide to participants within 60 days of adoption of the material reduction. If the material modification changes the SBC, provide to participants 60 days prior to the adoption of material modification. The plan can also send an updated SPD to satisfy this requirement.
Electronic Distribution: Email and other Internet-based methods that comply with the DOL safe harbor can be used.
Bywater Distribution Method: Direct to Employer
Plan Type: Plans Subject to COBRA
Notice/Disclosure: Election Notice
Requirements: The plan administrator must provide a notice to qualified beneficiaries that describes their rights to continuation coverage and how to make an election.
Other Disclosure Requirements: Provide within 14 days after the plan administrator receives the notice of a qualifying event (or 44 days after notice of a qualifying event if the employer is also the plan administrator and the qualifying event is a termination or reduction of hours of employment, the employee’s death, or the employee’s becoming entitled to Medicare). The plan may also have to provide an Unavailability of Continuation Coverage Notice and a Termination Notice if and when applicable.
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 or beneficiaries).
Bywater Distribution Method: COBRA administrator/Employer HR