Open Enrollment is a whirlwind for any group health plan, big or small. Staying compliant can feel like climbing a mountain, but don’t worry—your EHD team is here to guide you. We have the expertise on notice requirements to keep your plan in check. Grab your pen and get ready to conquer this OE checklist! Many of these notices may be covered within your annual Benefits Guide.

 All-size Group Health Plans:

  • Children’s Health Insurance Program (CHIP) Notice – This notice can be provided either as a complete list or by the states where your employees reside.
  • Newborns’ and Mothers’ Health Protection Act Notice – This should be included in your SPD (summary plan description) therefore a separate notice is not required.
  • Medicare Part D Creditable Non-Creditable Coverage Notice – While it is only required to provide this notice to Medicare-eligible individuals annually by October 15th, most employers choose to distribute it to all plan participants, regardless of their Medicare status.
  • Special Enrollment Rights Notice – All group health plans that are not “excepted benefits” such as standalone dental, vision, and flexible spending accounts (FSA) that have not adopted HIPAA’s special enrollment rules.
  • Summary Plan Description (SPD) – If restated due to plan changes or distribute an SMM (Summary of Material Modification).
  • Summary of Benefits and Coverage (SBC) and Uniform Glossary – The carrier will produce these documents for distribution.
  • Wellness Program Notice (ADA) – If your wellness program requires health information, the Americans with Disabilities Act (ADA) notice is required. This notice is required by the EEOC (Equal Employment Opportunity Commission). It will cover ADA, HIPAA, and GINA.
  • Wellness Program Disclosure Notice (HIPAA) – If program incentives are offered this notice will advise the rights for a reasonable alternative.  
  • Women’s Health and Cancer Rights Act Disclosure Notice (WHCRA) – Plans that cover benefits related to mastectomies.
  • Your Rights and Protections Against Surprise Medical Bills Notice
  • HIPAA Notice of Privacy Practices – The notice should be provided every three years for a self-funded group health plan. A fully insured group health plan that is not receiving any protected health information (PHI) other than a summary and enrollment does not need to provide this notice.  
  • The Uniformed Services Employment and Reemployment Rights Act Notice (USERRA)

Size Matters for these notices:

  • Wellness Program GINA General Disclosure Notice – Group sizes with 15 or more employees. If your wellness program requests or requires genetic information, provide this additional notice for The Genetic Information Nondiscrimination Act. 
  • Continuation Coverage Rights Under COBRA – Group sizes with 20 or more employees.  
  • Mental Health Parity and Addictions Equity Act (MHPAEA) Disclosure – Group sizes with 50 or more employees.

 Less common instances are when these notices count:

  • Grandfathered Plan Notice – All group sizes must comply. If your plan status is grandfathered as defined by the Affordable Care Act, provide this notice to all plan participants or face losing grandfathered status.
  • 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 therefore a separate notice is not required.
  • 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 therefore a separate notice is not required.
  • Notice to Enrollees Regarding Opt–Out—Provide this notice only if the plan is a self-funded nonfederal governmental group health plan that has opted out of some or all of HIPAA. The group is sponsored by self-funded state or local governments, whereas the government entity is paying for the health care costs.

If you need a copy of any of The Model Notices, please contact your Client Manager or Producer.