2018 Benefits Notices for Open Enrollment

By: Stephanie Edwards, Capstone Brokerage Benefits Account Manager, August 16, 2017

The 2018 heath benefits notices are part of the open enrollment for employee benefits. The documentation should be distributed and supplied to employees in compliance with employer’s obligations under the federal law. Some notices are to be provided annually, which is why many employers choose to include the documents during the company’s open enrollment period as an administrative convenience.

During open enrollment, employers may find it a beneficial time to review their plan designs, coverage options and contribution limits. During this review, any new plan requirements and design changes should be implemented to remain within the legal guideline for what is required for the 2018-2019 year. Any plan changes should be communicated during open enrollment with employees by utilizing a summary plan description or a summary of material modification within the allotted time frame to remain in compliance with the Affordable Care Act.

A Summary of Benefits and Coverage (SBC) must be provided at specific time during the open enrollment process and upon a plan participant’s request. The SBC can be added to other benefits materials if it is in the beginning of the materials and in accordance with the time requirements for providing a SBC. SBC should be provided in the following time frames:

Prior to initial enrollment in the plan;
• Upon renewal of plan coverage;
• Within 90 days of special enrollment; and
• Within 7 business days following receipt of a request

Notice of Special Enrollment Rights should also be provided at the time of an employee’s initial employment or when they are eligible to enroll in the group health care plan.

Heath Insurance Exchange notices should be provided within 14 days of a new employees start date.

Disclosure of Grandfather Status: should be provided with any coverage plan material if the coverage is part of a grandfathered group health plan and should include an explanation of the benefits provided.

Notice of Patient Protection: This document is used whenever a participant or enrolling employee is part of a non-grandfathered group health plan. These notice requirements are to provide a designation of participating primary care providers and should be included in the Summary Plan Description or with similar plan descriptions.

Wellness Program Disclosure: for employers who offer group health plans the requirement to also offer a wellness program is part of the Affordable Care act. The wellness program verbiage is important and should include the benefits of the wellness program that are available to employees, including but not limited to gym membership reimbursements, activity based and outcome based wellness programs. This documentation should be included in the plan materials provided at the time of open enrollment.

Notice of Privacy Practices: Health care plans that meet “covered entity” requirements must provide notice to new enrollees at the time of enrollment.

Women’s Health and Cancer Rights Act (WHCRA) Enrollment Notice: Employers that have group health care coverage for Mastectomy surgical benefits need to provide the employees with this form and information on how the coverage will work.

Employer Children’s Health Insurance Program also know as “CHIP” Notice: This notice should be included when using group health coverage in states that will provide premium assistance through Medicaid or CHIP. The notice must be provided to employees annually before the start of the plan year it may also be included with other documentations in open enrollment packets under the following conditions:

• The materials are provided before the start of each plan year;
• The materials are provided to all employees entitled to receive the CHIP notice; and
• The notice appears separately and in a manner that ensures employees can reasonably be expected to appreciate its significance.

Michelle’s Law Notice: this notice must be shared when there is a requirement for certification of student status under healthcare plans that base eligibility on the student’s enrollment in educational programs providing coverage to dependents past the age of 26.

Newborn and Mothers Health Protection Act Notice: If a group health care plan provided maternity or newborn infant coverage, this notice must also be included in the open enrollment packet from the employer to the employee.

Medicare Part D Creditable Coverage Disclosure Notice or Non—Creditable Coverage Disclosure Notice: If an employer is providing group health plans that will include the prescription drug coverage, they must provide a the notice to Medicare-eligible individuals before the start of the new policy prior to the effective date of the prescription drug plan enrollment and any time there is a change that will affect the coverages as creditable or non creditable. The initial enrollment period for Medicare Prescription drug benefits is October 15. This form must also be proved to an employee upon request.

ADA Notices Regarding Wellness Programs: This notice must be provided before an employee discloses health information for purposes relating to a wellness program allowing ample time for the employee to decide if they want to participate in the program. However, if the employer has already provided a notice to inform participants of wellness program what information will be collected, who will receive it, how it will be used, and how it will be kept confidential, this notice is generally not required.

ACA Section 1557 Nondescription Notice of Taglines: Those who are receiving federal financial assistance are required to post notice and taglines.

General Notice of COBRA Rights: Employers who have 20 or more employees and have sponsored group health plans must include information for the right to continue coverage in the plans summary Description (SPD) as well as in the SBC, as well as provide a notice during the first 90 days of coverage for the employee.

General FMLA Notice: The FMLA notice MUST be posted in a prominent area where the guidelines can be easily seen by all employees, in addition the FMLA notice should also be included in open enrollment packets. Employers with more then 50 employees must also include this notice in the employee handbook.

As a business, it is imperative to be in compliance with the 2018 benefit enrollment notice guidelines. If you have any questions regarding anything required contact a knowledgeable broker or your insurance carrier for more instruction.