ERISA and related federal health laws impose numerous disclosure and notice requirements on employers sponsoring group health plans. These obligations vary by timing, audience, and triggering event.
This page provides a structured overview of common group health plan notices, what they are, why they exist, and when they must be provided. It is not legal advice. Employers should consult qualified ERISA counsel to evaluate how these requirements apply to their specific plans.
Wrap Plan Consideration: Employers using an ERISA wrap structure should ensure required notices are properly incorporated into the Wrap SPD or distributed separately, as applicable. A wrap plan consolidates documentation, but it does not eliminate independent notice obligations under ERISA, the ACA, HIPAA, Medicare Part D, or other federal laws.
Foundational ERISA Plan Documents
These are not simply “notices.” They are core governing documents.
- ERISA Plan Document
- The formal legal instrument that establishes the plan and defines how it operates. Required under ERISA §402. Not distributed automatically but must be provided upon request.
- Summary Plan Description (SPD)
- The employee-facing explanation of plan rights, eligibility rules, claims procedures, funding arrangements, and ERISA protections. Must be distributed automatically within required timeframes.
- Summary of Material Modifications (SMM)
- Required when material changes are made to a previously issued SPD. Ensures participants are notified of benefit or administrative changes.
- Form 5500 Annual Report
- Public disclosure document required for certain plans depending on funding method and participant count.
Enrollment and Eligibility Notices
These notices protect employees at the point they first become eligible or enroll.
- HIPAA Special Enrollment Notice
- What it does: Explains an employee’s right to enroll mid-year if they lose other coverage, get married, have a child, adopt, or gain eligibility for Medicaid or CHIP.
- Why it exists: Prevents plans from permanently locking employees out of coverage due to life events.
- Timing: At or before initial enrollment opportunity.
- Notice of Exchange (Marketplace Notice)
- What it does: Informs employees about the existence of the Health Insurance Marketplace (state Exchange for individual and family plans) and potential ACA Premium Tax Credits.
- Why it exists: Ensures employees understand alternative coverage options and subsidy eligibility.
- Timing: Provided to all new hires, regardless of benefit eligibility status.
- Women’s Health and Cancer Rights Act (WHCRA) Enrollment Notice
- What it does: Informs participants that plans covering mastectomies must also cover breast reconstruction, symmetry surgery, prostheses, and treatment of complications including lymphedema.
- Why it exists: Ensures comprehensive post-mastectomy protections.
- Timing: Upon enrollment.
- Newborns’ and Mothers’ Health Protection Act (NMHPA) Notice
- What it does: Explains minimum hospital stay protections following childbirth.
- Why it exists: Prevents plans from limiting maternity stays below federally required standards.
- Timing: Generally included in the SPD, though can be distributed as a standalone notice. Unlike WHCRA annual notices or Medicare Part D notices, NMHPA is satisfied through plan documentation.
- Michelle’s Law Notice
- What it does: Protects dependent students who must take medically necessary leaves of absence.
- Why it exists: Prevents loss of coverage due to serious illness affecting full-time student status.
- Timing: Included with any notice regarding student status certification, if applicable.
- Note: Under the ACA, group health plans generally cannot condition coverage for adult children under age 26 on student status. As a result, Michelle’s Law has limited practical application for most major medical plans today, but it may still apply in limited circumstances where student status remains relevant under the plan
- HIPAA Notice of Privacy Practices
- What it does: Explains how protected health information is used and disclosed.
- Why it exists: Protects participant medical privacy.
- Timing: At enrollment and upon request for applicable plans.
Annual or Ongoing Notices
These disclosures must be redistributed on a recurring basis.
- Women’s Health and Cancer Rights Act (WHCRA) Annual Notice
- Annual reminder of mastectomy-related coverage protections. This is in addition to, and separate from, the initial WHCRA notice.
- Medicare Part D Creditable or Non-Creditable Coverage Notice
- What it does: Informs Medicare-eligible individuals whether the employer’s prescription drug coverage is “creditable” compared to Medicare Part D.
- Why it exists: Helps individuals avoid late enrollment penalties under Medicare.
- Timing: Annually before October 15 and upon certain qualifying events. Employers must also report coverage status to CMS.
- Children’s Health Insurance Program (CHIP) Reauthorization Act (“CHIPRA”) – Premium Assistance Notice
- What it does: Informs employees about potential Medicaid or CHIP premium assistance available in their state.
- Why it exists: Promotes coordination between employer coverage and public assistance programs.
- Timing: Annually.
- ACA Summary of Benefits and Coverage (SBC) and Uniform Glossary
- What it does: Provides a standardized summary of plan benefits and cost-sharing using federally prescribed formatting.
- Why it exists: Allows participants to compare health plans in a consistent format.
- Timing: At enrollment, renewal, special enrollment, and upon request.
- ACA 60-Day Advance Notice of Material Reduction
- What it does: Requires advance notice if a mid-year change materially reduces benefits or coverage.
- Why it exists: Prevents surprise reductions without advance warning.
- Timing: At least 60 days before the change takes effect.
Event-Triggered Notices
These apply when specific life events or plan events occur.
- COBRA General Rights Notice
- What it does: Explains continuation coverage rights if coverage is later lost due to qualifying events such as termination or divorce.
- Why it exists: Protects participants from abrupt loss of coverage.
- Timing: Within 90 days of enrollment in group coverage.
- COBRA Election Notice
- What it does: Provides specific continuation election instructions when a qualifying event occurs, as described in the COBRA General Rights notice.
- Why it exists: Gives individuals the legal opportunity to continue coverage.
- Summary of Material Modifications (SMM)
- Required when a material plan change is adopted.
- Timing: Within 210 days after the conclusion of the plan year in which the change occurred.
Scope and Applicability
This checklist reflects the most common federal health plan notices required under ERISA and related laws for active group health plans. It is not exhaustive.
Certain notices apply only in specific circumstances, such as:
- Grandfathered health plans under the Affordable Care Act
- Mental Health Parity and Addiction Equity Act comparative analysis documentation
- Multiemployer plans
- Retiree-only plans
- Plans subject to special funding or collective bargaining rules
Employers should evaluate whether any specialized or status-based notices apply to their plans. The absence of a notice from this checklist does not mean it is never required.
Model Notice Resources
The Department of Labor and other federal agencies publish model language for many required health plan notices. Employers are strongly encouraged to use these models when available, as they are designed to meet statutory content requirements.
- DOL EBSA “Compliance Assistance Guide – Health Benefits Coverage Under Federal Law
- Includes model language for WHCRA, HIPAA Special Enrollment, Newborns and Mothers Health Protection Act, etc.
- CMS Medicare Part D Creditable and Non-Creditable Coverage Notices
- Annual CHIP Premium Assistance Model Notice
- COBRA General Rights Notice, COBRA Election Notice
- ACA Marketplace Exchange Notice
Why This Matters
Many of these notices protect participant rights. Others protect employer fiduciaries by demonstrating compliance with federal law.
During a Department of Labor audit, investigators frequently request:
- SPDs/Wraps and SMMs
- Proof of COBRA notices
- Medicare Part D notices
- CHIPRA notices
- HIPAA special enrollment notices
It is not enough for the notice to exist. The employer must demonstrate that it was distributed properly and consistently. Documentation of timing, method of delivery, and audience is critical in demonstrating compliance.