Employers sponsoring group health plans should review their open enrollment materials to ensure required notices, such as the Summary of Benefits and Coverage (SBC), are provided on time. Annual notices, including the Women’s Health and Cancer Rights Act (WHCRA) notice, may also be included for convenience, while some notices may appear in the plan’s summary plan description (SPD) or benefits summary. Employers should confirm that materials accurately reflect coverage terms and costs and communicate 2027 plan design changes through an updated SPD or summary of material modifications (SMM).
Here’s a summary of benefit notices employers should provide at open enrollment time.
|
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. Employers are required to use a template. |
|
Medicare Part D Notice |
Employers with 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.” There are model notices for employers to use. |
|
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. There is a model notice guide for model language. |
|
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. There is a model notice for employers to use. |
|
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. If no materials modifications have been made, a notification must be provided at least every 10 years. |
|
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. There is a COBRA Model General Notice that can be used. |
|
Grandfathered |
Health plans that have grandfathered status under the Affordable Care Act (ACA) |
Notice must be provided in plan materials describing the plan’s grandfathered status. There is a model notice that can be used. |
|
Notice of Patient Protections |
Health plans that require designation of a participating primary health care provider |
If a group health plan requires participants to choose a participating primary care provider, the plan or issuer must provide a Notice of Patient Protections with the SPD or similar benefits description. This notice is often included in the SPD or benefits summary from the issuer or TPA. There is a model notice that can be used. |
|
HIPAA Privacy Notice |
Self-insured group health plans |
Self-insured health plans must provide HIPAA Privacy Notices at enrollment and at least every three years. For fully insured plans, issuers are primarily responsible for Privacy Notices. Notices should be included in open enrollment materials. Model templates are available. |
|
HIPAA Special Enrollment Notice |
All group health plans |
Group health plans must provide a HIPAA special enrollment notice to eligible employees at or before enrollment, typically included in enrollment materials or the plan’s SPD. |
|
Summary Annual Report (SAR) |
Group health plans subject to the Form 5500 filing requirement, except unfunded health plans, which are exempt |
Health plans required to file Form 5500 must provide a SAR to participants within nine months of the plan year’s end (or within two months after filing extension). Unfunded plans are exempt. A DOL model notice is available. |
|
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. Sample language is available in model notice guide. |
|
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. There is a sample notice for employers to use. |
|
Individual |
Employers that sponsor ICHRAs for specific classes of employees (or all employees) |
Employers may implement an ICHRA to reimburse 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. A model notice is available for employers to use. |
Download the bulletin for more details.
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