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Employers should be providing certain benefit notices to their employees at open enrollment time. This includes the summary of benefits and coverage (SBC). Other notices must be distributed annually, and employers often choose to include them in their open enrollment materials for convenience.
Some benefit notices apply to all group health plans while other notices only apply to certain group health plans, based on plan design and coverage. Employers should review their materials to ensure that they are accurately reflecting the terms and cost of coverage. Any plan design changes for 2024 should be communicated to employees through a summary of material modifications (SMM) or an updated plan description (SPD).
Here's a compliance overview chart that summaries the benefit notices for open enrollment.
|
Benefit Notice |
Applicability |
Description |
|
SBC |
Group health plans and health insurance issuers |
Group health plans and health insurance issuers are required to provide an SBC to applicants and enrollees each year at open enrollment or renewal time. |
|
Medicare Part D notice of creditable or non-creditable coverage |
Group health plans that provide prescription drug coverage |
Employers must notify Medicare Part-D eligible individuals before October 15th each year about whether the drug coverage is “creditable” or “non-creditable”. |
|
WHCRA notice |
Group health plans that provide medical and surgical benefits for mastectomies |
Notice must be provided at time of enrollment and on an annual basis after enrollment. |
|
Children’s Health Insurance Program (CHIP) notice |
Group health plans that provide a premium assistance subsidy under a Medicaid plan or CHIP |
The employer must send an annual notice about the available assistance to all employees residing in that state. The annual CHIP notice can be provided at any time during the year. |
|
SPD |
Group health plans subject to ERISA |
An SPD must be provided to new health plan participants with 90 days of the date their plan coverage begins. Notice can be included in open enrollment materials. An updated SPD must be provided to participants at least every five years if modifications have been made during that time. |
|
COBRA General Notice |
Group health plans subject to COBRA |
A written General Notice of COBRA Rights to covered employees must be provided 90 days after their health plan coverage begins. |
|
Grandfathered plan notice |
Health plans with grandfathered status under the Affordable Care Act (ACA) |
Notice must be provided in plan materials describing the plan’s grandfathered status. |
|
Notice of patient protections |
Group health plans that require designation of primary care provider |
The plan or issuer must provide this notice whenever the SPD is provided to participants. |
|
HIPAA privacy notice |
Self-insured group health plans |
Plans must send privacy notices at certain times including to new enrollees at the time of enrollment. At least once every three years, plans must either redistribute the notice or notify employees about its availability. |
|
HIPAA special enrollment notice |
All group health plans |
Include notice in enrollment materials. Notice lets employee know about their special enrollment rights under HIPAA. |
|
Wellness notice – HIPAA |
Group health plans with health-contingent wellness programs |
The notice informs employees about an alternative way to qualify for the program’s reward. Notice must be included in all plan materials that describe the terms of the wellness program. |
|
Wellness notice – ADA |
Wellness programs that collect health information or include medical exams |
This notice complies with the Americans with Disabilities Act (ADA) and explains how the information will be used, collected, and kept confidential. Notice should be included in open enrollment materials. |
|
Individual coverage HRA (ICHRA) notice |
Employers that sponsor ICHRAs |
Employers may implement an ICHRA to reimburse their eligible employees for insurance policies purchased on the individual market or Medicare premiums. Notice must be provided 90 days before the beginning of each plan year. |
Download the bulletin for more details.
National Insurance Services is not a law firm and no opinion, suggestion, or recommendation of the firm or its employees shall constitute legal advice. Readers are advised to consult with their own attorney for a determination of their legal rights, responsibilities and liabilities, including the interpretation of any statute or regulation, or its application to the readers’ business activities.
