Many of the annual notices are included in your Benefits Guide (BG). Perfect for distribution at open enrollment and for new hires. Some notices are based on the Employer Group Health Plan (GHP) employee size and funding mechanism – fully insured (FI) and self-funded (SF). All notices should be provided within 30 days of a request unless otherwise stated.

 All-size employers and funding for these Notices:

  • Children’s Health Insurance Program (CHIP) Notice – This notice can be provided either as a complete list or by the states where your employees and their dependents reside. Each state offers a premium assistance subsidy for GHPs, a separate state plan, or Medicaid coverage. Distribution is annual. There is a model notice. (BG)
  • Newborns’ and Mothers’ Health Protection Act Notice – Distribution at time of plan enrollment and within the SPD (summary plan description). There is model language. (BG)
  • Medicare Part D Creditable Non-Creditable Coverage Notice – Employers are required to provide one of the notices (available in English and Spanish) to Medicare-eligible individuals annually by October 14th. However, most employers choose to distribute this notice to all plan participants, regardless of age. Any GHP that offers prescription drug coverage must distribute a creditable or non-creditable determination notice. If you have a FI plan, the carrier will advise whether your plan is credible. If you are SF, you may need to complete a stand-alone determination. Distribution is annual, at the time of plan enrollment, and if the credible status changes. There is a model notice. (some BG)
  • Special Enrollment Rights Notice – All GHPs that are not considered “excepted benefits” (such as standalone dental, vision, and flexible spending accounts) must adopt HIPAA’s special enrollment rules. These rules provide coverage for qualifying life events (QLEs). Employees must request enrollment within 30 days of the event, or within 60 days if the event is related to Medicaid or CHIP. Distribution at time of plan enrollment. There is model language. (BG)
  • Summary Plan Description (SPD) – The SPD must be distributed as follows:
    • New Plans: Within 120 days after the plan is established
    • Newly Covered Participants: Within 90 days after the participant first becomes covered under the group health plan
    • Ongoing Participants:
  • If material changes occur, redistribute the SPD within 210 days after the end of the plan year in which the change was adopted
  • If no material changes occur, redistribute the SPD within 210 days after the end of the tenth plan year
  • All Participants: For a negative plan change or a change that modifies the SBC outside of OE, an updated SPD, SBC, or SMM (Summary of Material Modification) must be provided at least 60 days prior to the effective date of the change.
  • Summary of Benefits and Coverage (SBC) and Uniform Glossary – The carrier will produce these documents for the plan administrator to distribute. Distribution is annual at renewal or re-enrollment, time of plan enrollment, special enrollment, or if a material modification is made. If an employee requests it, provide it within 7 business days.
  • Wellness Program Notice (ADA) – If your wellness program collects health information, you must provide an Americans with Disabilities Act (ADA) notice. This notice, mandated by the Equal Employment Opportunity Commission (EEOC), explains what information will be collected, how it will be used, who will have access, and how it will be protected. The notice can also include HIPAA requirements (reasonable alternative & nondiscrimination) where incentives are offered, and the Genetic Information Nondiscrimination Act (GINA) (when genetic information is collected) if applicable. A separate HIPAA and GINA notice is only required if the language is not included in this notice. Distribution before any health information is provided, anytime health information is requested, and before participation in the wellness program. There is a model notice, which must be tailored to each program. (some SBG)
  • Wellness Program Disclosure Notice (HIPAA) – If your wellness program offers incentives, it must include a reasonable alternative standard and comply with HIPAA nondiscrimination rules. Health-contingent programs (activity-only or outcome-based) must allow for special enrollment. These programs must comply with nondiscrimination rules and prohibit discrimination based on health factors. Distribution is annual, at the time of plan enrollment, and if the program terms change. There is no model notice, but this information can be incorporated into the ADA Wellness Program Notice.
  • Women’s Health and Cancer Rights Act Disclosure Notice (WHCRA) – GHPs that include benefits related to a mastectomy must provide the notice and cover all stages of reconstructive surgery, symmetrical surgery for the other breast, prostheses & physical complications. Distribution is annual, at the time of plan enrollment, and must be tracked. There is model language. (BG)
  • Your Rights and Protections Against Surprise Medical Bills Notice – Distribution is generally handled by the providers, carriers, and facilities but the GHP should include language in the SPD. There is a model notice. (BG)
  • HIPAA Notice of Privacy Practices – For SF GHPs, distribution is at the time of plan enrollment, every three years thereafter, or within 60 days of a material change. FI GHPs that do not receive any protected health information (PHI) beyond summaries and enrollment details are not required to provide this notice, as the carrier will manage it. There is a model notice.
  • The Uniformed Services Employment and Reemployment Rights Act Notice (USERRA) The employee notice of rights can be satisfied by posting the official USERRA poster in a conspicuous place, displayed alongside other mandatory workplace posters. The official notice can be obtained from the Department of Labor (DOL). It can also be included in the employee handbook or benefits guide. (SBG)
  • Marketplace Notice of Exchange – All employers that must comply with FLSA must comply. Distribution to all new employees, regardless of their eligibility status for the GHP, within 14 days of hire. Redistribution is not necessary. There are two model notices, one for employers that offer a GHP, and one for those that do not offer a GHP.

Size and Funding differ for these Notices:

  • Wellness Program GINA General Disclosure Notice – Group sizes with 15 or more employees.If the GHP requests or requires genetic information, the Genetic Information Nondiscrimination Act (GINA) requires a notice. The notice must state that providing genetic information is voluntary, explaining how the information will be used and protected, and comply with EEOC guidelines. The plan cannot charge higher rates or contributions based on genetic information, nor collect family history for employment purposes. Distribution must occur before the employee completes the health risk assessment or biometric screening, at the time of plan enrollment, and anytime health information is requested.  There is a model notice. (SBG)
  • COBRA Continuation of Coverage Rights/General Notice/Initial Notice – Group sizes with twenty or more employees. Mini-COBRA state laws could be applicable to employers with fewer than 20 employees. Distribution is within 90 days from the time of plan enrollment, often included in the SPD, can be sent separately by either the employer or the COBRA administrator, or included in the benefits guide. There is a model notice. (SBG)
  • Mental Health Parity and Addictions Equity Act (MHPAEA) Disclosure – All group sizes that provide mental health or substance use disorder benefits should include a general disclosure in the SPD or benefits guide. The responsibilities differ. There is no model notice. Comparative Analysis (CA) and Fiduciary Attestation (FA). (BG)                                                                                                                          
  •  a. Self-funded companies with fifty or more employees are responsible for completing the CA and FA.  Disclose.  
  • b. Self-funded companies with fewer than 50 employees are exempt from the CA and FA.   
  • c. Fully insured companies of all sizes must request a CA from the carrier and complete the FA. Disclose.  

 Less common instances of these Notices:

  • Grandfathered Plan Notice – All group sizes must comply. If your plan is grandfathered under the ACA, you must include the notice every time you distribute materials that describe plan benefits, such as the SPD, benefits guide, enrollment packets, or other communications. This notice should also be provided annually to all plan participants. Failure to include the notice as required could result in the plan losing its grandfathered status. Be certain to document all distributions. There is a model notice. (SBG)
  • Michelle’s Law Notice – All group sizes must comply. If your plan covers dependents over age 26 enrolled in school, the notice pertains to a medical leave of absence for the dependent. This should be included in your SPD or any benefits materials that describe dependent eligibility. There is no annual distribution requirement. There is no model notice. (SBG)
  • Patient Protection Notice – All group-size non-grandfathered plans that require a primary care physician (PCP) designation for plans such as an HMO (health maintenance organization) must comply. This should be included in your SPD and any materials that describe benefits, including the benefits guide. There is no annual distribution requirement. There is a model notice. (SBG)
  • Notice to Enrollees Regarding HIPAA Opt–Out – This notice should be provided only if the plan is a self-funded nonfederal governmental group health plan that has opted out of certain HIPAA requirements. These plans are sponsored by self-funded state or local governments, where the government entity covers the health care costs. Distribution is annual and at the time of plan enrollment. There is model language.