There are a number of Compliance Notices that should be distributed during open enrollment. To help you stay ahead of those items, we have made a number of documents available in one location.

Medicare Part D Creditable or Non-Creditable Coverage Notice

Covered employees or covered dependents who are enrolled in Medicare may choose to stay on their employer’s group medical plan instead of enrolling in a Medicare Supplement and Part D drug coverage.  An employer must deliver a Notice of Creditable (or Non-Creditable) Coverage to those employees or dependents on Medicare.  Since you may have no way of knowing who may be enrolled in Medicare, there is wisdom in distributing the appropriate notice each year at renewal.  Generally, group medical plans with Copay prescription coverage and HSA-eligible plans with deductibles of $2,500 or less have “Creditable” drug coverage.  Higher deductible plans may not.  Once your renewal plan selection is completed, we will be happy to help you determine which notice is appropriate.

Children’s Health Insurance Plan (CHIP) Notice

Similar to the Medicare Part D notice in that it doesn’t need to go to everyone (only those with children, grandchildren, etc. who may be eligible for enrollment in a State’s plan), it will not hurt to distribute to all just to make sure that you do not miss getting it to an interested party.  The Model CHIP Notice on our web site is ready for distribution as it is.

Notice for Employees

CHIP Notice - Model Employer

Model Exchange Notice

Prior to October 1, 2013, employers had to send a written notice about the availability of Health Insurance Exchanges (HIE’s).  After that, distribution was only required for newly hired, regardless of eligibility for any benefit plans—both full-time and part-time. Since this can be posted electronically, you may choose to send it out again just to be certain that all employees have received it at least once.  Our document file contains the Model Exchange Notice for employers both with and without group medical plans, be certain to select the appropriate version.

Summary of Benefits and Coverage (SBC)

As to your SBC, it should be distributed to each participant in their respective plan.  Distribution can be in the form of a pay-stuffer, mailed, e-mailed, or posted on an internal web site so long as all members have access to it and are notified that it is there (i.e. via e-mail).  Each SBC is plan and plan year specific, and we will provide an updated SBC to you once a renewal plan has been chosen.  The two articles here are for information only at this time.

Notice for Employees

This will be provided the insurance carrier.

Summary Plan Description (SPD)

Much of what needs to be provided in an SPD is covered in the employee’s insurance certificate provided by the insurance company.  The balance of the information that we suggest can be found in the Sample SPD on our web site.  This Sample SPD is designed specifically for use with an existing insured medical plan so there is minimal duplication of the information provided in the insurance company’s Certificate of Coverage.

Notice for Employees

This will be provided by a Third Party Administrator (TPA) or legal entity.

Women's Health and Cancer Rights Act

The Women’s Health and Cancer Rights Act (WHCRA) requires group health plans and health insurance issuers that provide medical and surgical benefits for mastectomies to also provide benefits for reconstructive surgery.  This verbiage is generally found in your medical plan’s certificate of coverage, but if it is not present you may use the information below.

WHCRA Notice Requirement

WHCRA Model Notice

Women's Health and Cancer Rights Act of 1998