This checklist contains a general list of notices an employer sponsoring group health coverage must create, distribute, and/or redistribute to employees.
Please note this is a general list only and is not considered legal advice. An employer should seek legal counsel to ensure it is in full compliance with ERISA law and other parts of health insurance compliance specific to the employer’s own business and circumstances.
For more information on these notices, reference the Self-Compliance Tool for Part VII of ERISA: Health Care-Related Provisions from the Department of Labor (beginning on page 62). This self-compliance tool is intended to help group health plans, plan sponsors, plan administrators, health insurance issuers and other parties determine whether a group health plan is compliant with certain provisions of Part VII of ERISA, which includes many of the following items.
ERISA Plan Document
Legal document, created by the employer with assistance from an ERISA Third Party Administrator (TPA) or legal counsel, which governs the health plan. It generally contains information included in the plan’s Evidence of Coverage (EOC) and other eligibility and funding information set by the employer.
Timing: Must distribute within 30 days to employees upon request
ERISA Summary Plan Descriptions (SPDs)
Summarized description of the corresponding Plan Document for each plan, created by the employer with assistance from an ERISA TPA or legal counsel; must be considered sufficiently accurate and comprehensive to reasonably apprise participants/ beneficiaries of their rights and obligations under the plan. Note: ERISA SPDs and other notices may be combined together in one document, known as an ERISA wrap.
Timing: Must deliver to covered participants within 90 days of plan enrollment (or 120 days for new plans), must update & redistribute every five years if there have been material modifications, or must redistribute every ten years if there have been no material modifications.
ERISA Summary of Material Modification (SMM)
If applicable, the employer must create and distribute an ERISA Summary of Material Modification (SMM) document any time there is an important change in benefits or other terms of coverage in a previously-distributed SPD.
Timing: To covered participants within 210 days after the conclusion of the plan year, as applicable.
Summaries of Benefits and Coverage (SBCs) and Uniform Glossary
A template that describes the benefits and coverage under the plan, and a uniform glossary defining statutorily and NAIC recommended terms. The SBC must include an internet address where an individual can review the Uniform Glossary, as well as contact information for obtaining a paper copy.
Timing: SBC must be provided to participants and beneficiaries with enrollment materials and upon renewal or reissuance of coverage. SBC must also be provided to special enrollees no later than the date by which an SPD is required to be provided (90 days from enrollment). The SBC and a copy of the Uniform Glossary must also be provided upon request within 7 days.
ACA 60 Day Notice of Material Modification
If applicable, employers must distribute this notice when changes to a group’s health plan occur at any time other than renewal.
Timing: Must distribute at least sixty days before the change can take effect
Notice of Exchange
Employers subject to the Fair Labor Standards Act (FSLA) must provide a written notice informing the employee of the existence of the Marketplace, the potential availability of a tax credit and that an employee may lose the employer contribution if the employee purchases a qualified health plan.
Timing: Notice must be provided to all new employees.
Women’s Health and Cancer Rights Act (WHCRA) Enrollment Notice (§713(a))
A statement for participants and beneficiaries who are receiving mastectomy related benefits, that coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:
- All stages of reconstruction of the breast on which the mastectomy was performed;
- Surgery and reconstruction of the other breast to produce a symmetrical appearance;
- Prostheses; and
- Treatment of physical complications of the mastectomy, including lymphedema.
A description must be included of any annual deductibles and coinsurance limitations applicable to such coverage.
Timing: Upon enrollment in the plan.
Women’s Health and Cancer Rights Act (WHCRA) Annual Notice
A copy of the WHCRA enrollment notice, -or-A simplified disclosure providing notice of the availability of benefits for the four required coverages and information on how to obtain a detailed description.
Timing: Once each year after enrollment in the plan.
Newborns’ and Mothers’ Health Protection Act Notice (§711(d); 29 CFR 2520.102-3(u))
The plan’s SPD must include a statement describing any requirements under Federal or State law applicable to the plan, and any health insurance coverage offered under the plan, relating to any hospital length of stay in connection with childbirth for a mother or newborn child. If the Federal law applies in some areas in which the plan operates and State law applies in other areas, the SPD should describe the different areas and the Federal or State requirements applicable in each.
Timing: In the SPD (or SMM).
Notice Regarding Premium Assistance Under Medicaid or CHIP (Children’s Health Insurance Program)
Potential opportunities currently available in the State in which the employee resides for premium assistance under CHIP or Medicaid for health coverage for the employee or the employee’s dependents. Information on how to contact the State in which the employee resides for additional information on premium assistance under these programs. Description of special enrollment opportunity if eligible for premium assistance under these programs.
Timing: May be provided with enrollment packets, open enrollment materials, or the Summary Plan Description.
Model Notice: Model Notice – Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
Michelle’s Law Notice
Must include a description of the Michelle’s law provision for continued coverage during medically necessary leaves of absence.
Timing: Notice must be included with any notice regarding a requirement for certification of student status for coverage under the plan.
Note: Under the Affordable Care Act, plans cannot deny or restrict coverage for a child under the age of 26 based on student status. A model notice for Michelle’s Law is not available.
Medicare Part D: Notice of “Creditable” or “Non-Creditable” Coverage Notice
Notifies Medicare-eligible employees or dependents of their drug coverage status (“Creditable” or “Non-Creditable”). If the coverage is non-creditable, the person will have to pay a future penalty for Medicare Part D Coverage if they do not enroll in Medicare Part D.
Timing: On or before October 15th every year, to all Medicare-eligible employees or dependents
Note: Employers with Medicare-eligible employees or dependents must also disclose “Creditable” or “Non-Creditable” coverage status to CMS annually
Notice of special enrollment rights under HIPAA
A description of individuals’ special enrollment rights.
Timing: At or before the time an employee is initially offered the opportunity to enroll in a group health plan.
COBRA General Rights Notice
Explains COBRA rights upon the future occurrence of a qualifying event.
Timing: Must distribute to covered individuals within 90 days of enrolling in the plan (includes dependents)
Model Notice: Model General Notice of COBRA Continuation Rights