by
Ben Cohen, CEBS
Practice Leader – Health and Welfare Benefits
Kushner & Company
As benefit and open enrollment planning begins for many
organizations each fall, it should be remembered that there are a number of
annual health plan notices that must be sent to plan participants each year.
Below is a list of notices to keep in mind, and ensure that they are sent as
necessary.
Medicare Part D
Each year, you must distribute the Notice of Creditable
Coverage required under Medicare Part D, which informs participants whether the
prescription drug coverage offered under your health plan is considered
creditable or non-creditable coverage. The Notice of Creditable Coverage must
be provided:
At least once a year before October 15th (a
new date this year, and the start of the annual Medicare Part D enrollment
period).
Whenever a Medicare-eligible employee enrolls in your health
plan. You may also simply include this as part of your new-hire package to
employees.
Whenever there is a change in the creditable or
non-creditable status of your health plan’s prescription drug coverage.
Whenever an individual requests the notice.
Each year within 60 days of the beginning of the plan year, the employer must
also report to CMS whether your prescription drug coverage is creditable or
non-creditable coverage. This must be electronically submitted via a Disclosure
to CMS Form. Additional information can be found here.
You may wish to contact your insurance carrier, TPA, and/or prescription drug
PBM for information on your plan(s).
Women’s Health and Cancer Rights Act of 1998 (WHCRA)
At the initial enrollment and each year following, notice
must be provided to plan participants regarding the availability of benefits
for the treatment of mastectomy-related services, including reconstructive
surgery, prostheses, and physical complications, including lymphedemas covered
by the plan. Information must also be provided on how to obtain a detailed
description of the mastectomy-related benefits available under the plan. More
information can be found here.
You may wish to contact your insurance carrier or TPA to see if they offer
assistance on this notice.
HIPAA Notice of Privacy Practices
For employers who have enacted HIPAA Privacy Policies and
Procedures, including those who receive Protected Health Information (PHI) and
those that sponsor an FSA or HRA, an initial Notice of Privacy Practices was to
have been provided to all plan participants at the adoption of the Policies and
Procedures. Additionally, the participants must be made aware of the
availability of and how to obtain the Notice of Privacy Practices at least once
every three years.
Notice of Grandfather Status
If Grandfathered status is maintained under PPACA, a plan
must include a notice in any plan materials given to existing and new employees
and COBRA beneficiaries describing the benefits provided under the plan that
they believe it is a grandfathered plan within the meaning of Section 1251 of
the PPACA, and provide contact information for employees with questions. This
notice must be provided for each year a plan maintains its grandfather status.
This notice can be included as part of the open enrollment materials given to
employees and COBRA beneficiaries.
Annual Children’s Health Insurance Program (CHIP) Notice
The Children’s Health Insurance Program Reauthorization Act
of 2009 (CHIPRA) extended and expanded the Children’s Health Insurance Program
(CHIP). States may choose under the Act to subsidize the cost of covering
eligible children and families in employer health plans. In addition, employers
are required to provide certain special enrollment rights related to the
available coverage. Employers are also required to provide an annual written
notice to employees about the potential premium assistance through this
program.
The notice requirement applies to employers that offer any group health plan
coverage (other than a plan that provides only HIPAA excepted benefits) to
employees who reside in a state that offers a CHIP subsidy program, which most
states do. The notice must be provided to all employees who reside in a state
that offers such a program, even those who are not eligible to enroll in the
plan. See the below link for information about individual state programs.
The notice must inform employees of the potential premium assistance available
for coverage under the employer’s plan, and contain contact information for the
state program. The DOL has posted a CHIP model notice.
The model also includes contact information for all 40 states that currently
offer a CHIP subsidy program. By listing all of the state information in one
notice, an employer can send the same notice to all employees rather than
creating a customized notice for each state.
The annual notice must be provided by the first day of the plan year. An
employer that misses the deadline is subject to a civil penalty of up to $100
per employee per day that the notice is late.
For more information, please contact SBAM at (800) 362-5461.