Summaries of Benefits & Coverage, Patient Protection Disclosures, Medicare Part D Creditable Coverage, Grandfathered Plan Notices, Model Exchange Notice, Health FSAs and COBRA Qualified Beneficiary Communications!

1. MODEL EXCHANGE NOTICE
MEDICARE PART D CREDITABLE COVERAGE
PATIENT PROTECTION DISCLOSURES
GRANDFATHERED PLAN NOTICES
HEALTH FSAs
All applicants and enrollees for all group health plans, excepted
for those that are excepted benefits under HIPAA.
WHO
This requirement began with open enrollment periods after
September 23, 2012. This is required to be sent annually.
WHEN
The purpose is to allow health care consumers compare coverage
options and choose what is best for them.
WHAT
This requirement applies to all employers that are subject to the Fair
Labor Standards Act. The notice must be sent to all current employees.
WHO
The notice must be sent no later than October 1, 2013. After that,
the notice must be provided to all new hires at the time of hire.
WHEN
Information on: Existence of the Marketplace, services provided by
the Marketplace, how employees may contact the Marketplace, etc.
WHAT
SUMMARIES OF BENEFITS & COVERAGE
All employer-sponsored plans that offer a prescription drug
benefit must annually notify participants as to whether their
coverage is creditable or non-creditable.
WHO
The deadline to mail these notices is October 15 each year.
WHEN
This will require notices to go out prior to most plans being
finalized. Any changes in creditable status once a plan is finalized
will require another round of notices to be sent.
WHAT
With ACA, employers must notify participants of their right to
designate any primary care provider who participates in the network.
WHO
Must be provided whenever the plan provides an SBC. Must be
provided no later than the first day of the first plan year beginning
on or after September 23, 2010, and annually thereafter.
WHEN
This notice provides information regarding rights to choose a
primary care provider or obtain obstetrical or gyneological care
without prior authorization.
WHAT
Open enrollment packet must be sent to: Possible Electees,
Electees or Continuees.
WHO
This is a requirement that states employers provide the same rights
to COBRA Continuees during an open enrollment period that are
offered to active employees.
WHEN
The Open Enrollment Notification is required even if the only
change is the COBRA rates.
WHAT
ACA requires that this notice be provided to all participants if the
plan is to maintain its grandfathered status.
WHO
This requirement began with open enrollment periods after
September 23, 2012. This is required to be sent annually as long as
the group health plan maintains its grandfathered status.
WHEN
A notice explaining that the plan or coverage is a grandfathered
health plan with the ACA definition.
WHAT
If the Health FSA is HIPAA-excepted and the employer need only
offer COBRA when the FSA account is underspent, then the COBRA
obligation ends at the end of the first plan year.
WHO
During open enrollment period.
WHEN
Included with open enrollment notification of available coverages.
WHAT
ANNUAL NOTICE
COBRA QUALIFIED BENEFICIARY COMMUNICATIONS
copyright 2013