Summary of Benefits and Coverage (SBC)
Per the Affordable Care Act, group health plans or health insurance issuers must provide participants and beneficiaries with a Summary of Benefits and Coverage (SBC) each year during open enrollment or at renewal time. The SBC should be written in short, plain language that makes it easy for applicants and enrollees to understand the health benefits available to them, and this should be included in the open enrollment kit.
Summary Plan Description (SPD)
Employers with group health plans must give new participants a summary of the plan document — also called a Summary Plan Description (SPD) — within 90 days of the participant’s coverage start date. You must furnish participants with an updated SPD every five years if changes are made to the SPD during that five-year span. You must give participants a new SPD every 10 years if no modifications are made to the SPD during the 10-year period.
COBRA General/Initial Notice
Employers who are subject to the Consolidated Omnibus Budget Reconciliation Act (COBRA) must provide each covered employee and each covered spouse with an initial COBRA notice within 90 days after coverage under the plan begins. The general or initial notice — which describes employees’ general COBRA rights and obligations — should be included in your open enrollment materials to ensure timely receipt by new enrollees.
HIPAA Privacy Notice
Under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, employers with self-insured plans must provide their own privacy notices to new participants upon enrollment. However, if the plan is fully insured, the health insurance carrier (not the employer) must provide the privacy notices.
HIPAA Wellness Program Notice
Employers with health-contingent wellness programs must notify employees that there is an alternative way of qualifying for the program’s reward. This notice must be included and distributed with other plan materials that describe the wellness program. For example, if the wellness program materials will be distributed during open enrollment or at renewal time, be sure to include this notice.
ADA Wellness Program Notice
Employers who are subject to the Americans with Disabilities Act (ADA) and who have a wellness program that includes medical exams or health-related questions must tell employees what information will be collected and how the information will be used and kept confidential.
This notice must be given to employees before they divulge any health information and with enough time for them to decide whether they want to participate in the program. If you will be implementing a wellness program in the upcoming plan year, consider putting this notice in your open enrollment kit.
If your group health plan includes mastectomy-related benefits, you must deliver a written notice to participants describing their right to benefits under the Women’s Health and Cancer Rights Act (WHCRA). This notice must be given at the time of enrollment or annually after enrollment.
Depending on your situation, you may need to provide other notices — such as the Grandfathered Plan Notice, Medicare Part D Notice, HIPAA Special Enrollment Notice, Children’s Health Insurance Program (CHIP) Notice, or Notice of Patient Protections.
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