ACA/ERISA Compliance Notices

 

Employers are required to provide employees with a variety of notices advising them of their rights and responsibilities. The Affordable Care Act (ACA) added to the already overwhelming amount of mandatory notices required for employers to remain compliant. Collecting and completing these notices are time-consuming – let us reduce the impact of this burden on your workload.

 

Failure for not providing all the required notices – $110 per day, with no cap

 

All employers are responsible for providing these written notices to benefit eligible employees to be in compliance

 

 

Health Insurance Exchange Notice

On or before October 1, 2013, for all current Employees, New Hires – On or after October 1, 2013.  No later than 14 days from employee’s start date.

 

Individual Bill of Rights - Simple/Detailed

 

 

Employer Required Model Notices

 

If you are not sure if your Group Health benefit plan is (or has maintained) Grandfathered Status please check with your insurance agent (or contact us).   Most group health plans are non-grandfathered plans.  If your health plan has renewed with changes or you have changed carriers, most likely, your group health plan is a non-grandfathered plan.    

 

 

Non-Grandfathered or Grandfathered Plan Notices

 

 

Grandfathered Plan Disclosure Notice

The notice must disclose that the plan is grandfathered and must include contact information.

 

Patient Protection Notice

When applicable, it is important that individuals enrolled in a plan or health insurance coverage know of their rights to (1) choose a primary care provider or a pediatrician when a plan or issuer requires designation of a primary care physician; or (2) obtain obstetrical or gynecological care without prior authorization.

 

Women's Health & Cancer Act

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA).

 

Children's Health Insurance Program Re-Authorization Act (CHIP)

If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from your employer, your State may have a premium assistance program that can help pay for coverage.

 

Dependent to age 26 Notice - HIPAA Special Enrollment Rights

The interim final regulations extending dependent coverage to age 26 provide transitional relief for a child whose coverage ended, or who was denied coverage (or was not eligible for coverage) under a group health plan.

 

 

Other Notices

 

 

Wellness Program Disclosure (only if you provide a Wellness Plan)

Required for group health plans offering a wellness program that requires an individual to satisfy a standard related to a health factor, the following is model language that may be used to satisfy the requirement that the availability of a reasonable alternative standard is disclosed.

 

HIPAA Notice of Privacy

A covered entity (Employer-Sponsored Health Plan) must make this notice available to any person who asks for it, a covered entity (Employer-Sponsored Health Plan) must prominently post and make available this notice on any website it maintains that provides information about its customer services or benefits.

 

Newborn's Act Disclosure

The following is language that group health plans subject to the Newborns’ Act may use in their SPDs to describe the Federal requirements relating to hospital lengths of stay in connection with childbirth.

 

General Notice of Pre-Existing Condition

Plans and issuers are required to give written notice that the lifetime limit on the dollar value of all benefits no longer applies and that an individual if covered, is once again eligible for benefits under the plan.

 

"Optional" Declination of Coverage

If you are declining Group health benefits enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan.

 

List of Model Notices

A table that provides a checklist of the specific notices and disclosures under health care reform. For each topic, a description of the notice or disclosure, effective date/timing of distribution, and who is required to comply.

 

Medicare Part D Creditable Coverage Notice

 

 

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