Navigating The Criteria For Open Enrollment Notice.

The plan sponsor or plan administrator is frequently in charge of compliance.

We are approaching fall open enrollment, and plan sponsors and administrators are getting ready to provide their staff the necessary notices about their health and welfare programs. Health and welfare plans now have more complicated notice and disclosure requirements, with some information needed upon sign-up and other requirements coming up annually. These letters may be created or distributed by insurers and third-party administrators, but the final liability for compliance frequently lies with the plan sponsor or plan administrator.

The following is a summary of some of the notices that are typically included in open enrollment documents.

• Health Insurance Portability and Accountability Act of 1996 (HIPAA) Special Enrollment Notice: Information about mid-year enrollment requirements must be given at or before the time the employee is first given the chance to sign up for the plan.
• Employees who live in a state that provides a premium assistance program under Medicaid or CHIP must receive notice each year that they are eligible for it. This notice is known as the Children’s Health Insurance Program (CHIP) Notice or Notice of Eligibility for State Premium Assistance.
• Notice of Creditable Coverage under Medicare Part D: This notice must be sent by October 15 and may be sent with open enrollment materials. Since it is frequently challenging to determine who is qualified for Medicare Part D coverage, many employers give the notice to everyone covered by the plan. The notice must be given to individuals enrolled or seeking enrollment in the plan who are eligible for coverage under Medicare Part D.
• Women’s Health and Cancer Rights Act (WHCRA) Notice: Participants must get notice every year about benefits for reconstructive surgery due to mastectomy and related conditions.
• Summary of Benefits and Coverage (SBC): In a number of situations, such as with initial and annual enrollment documents, notice must be given to everyone enrolled in the plan.
• Wellness Program Notices: HIPAA mandates that any plan materials outlining the parameters of the wellness program provide information about alternative standards that may be available for obtaining health-related benefits. Before any medical information is gathered or any medical examinations are performed, the Americans with Disabilities Act (ADA) generally requires the dissemination of a notice concerning the collection and use of medical information in conjunction with a wellness program (and with enough time for the employee to decide whether to participate in the program).
• HIPAA Notice of Privacy Practices: Individuals covered by a group health plan must be informed of the notice’s availability (or a complete copy of it) at the time of enrollment, and subsequently, it must be done at least once every three years. To make compliance easier, many plan sponsors will include the HIPAA privacy notice (or information about its availability) in their yearly open enrollment materials.

For many of these mandatory notices, model documents and templates are available; nevertheless, it is frequently necessary to alter these to reflect the unique design and administrative procedure of the applicable plan. Sponsors of plans should also think about any notice requirements imposed by state law. Employers are required to inform employees of the essential health benefits that are and are not covered by the employer-sponsored health plan, for instance, in accordance with the Illinois Consumer Coverage Disclosure Act.

Employers are increasingly doing the annual enrollment procedure online, and they frequently use electronic media to deliver the legally needed notices. The use of the employer’s computer systems to provide the disclosure to qualified employees with access to work-related computers would be permitted under the current Department of Labor safe harbor for electronic distribution of health and welfare plan materials. To qualify for this safe harbor, an employee must be able to access the documents from a place where they may lawfully execute their job obligations and where using an electronic system is a necessary component of those tasks.

Alternately, businesses can ask for the employee’s permission before sending out information electronically. If electronic distribution is used, employers should determine which people might not have access to it and how to reach them with an alternative method of disclosure (e.g., regular U.S. mail or hand delivery). Employees on leave who would not immediately have access to work-related electronic systems, COBRA participants, and individuals whose jobs don’t often need connection with electronic systems are among the groups who could be impacted (e.g., cleaning staff or cafeteria workers). Remember that certain mandated notices (such the COBRA and HIPAA privacy disclosures) may be subject to unique electronic disclosure regulations.

Employers will want to make sure that enrollment materials are comprehensive and effective communications to help eligible employees make educated decisions about their benefit plan options, separate from the steps they take to ensure enrollment materials comply with the various legally required disclosures. Sponsors of health and welfare programs have various more notice and disclosure duties in addition to those outlined in enrollment documents.

Source: https://www.benefitspro.com/2022/11/15/navigating-open-enrollment-notice-requirements/