Some of the notices routinely included in open enrollment materials are listed below.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Special Enrollment Notice: Notice regarding mid-year enrollment rules must be provided at or before the time the employee is initially offered the opportunity to enroll in the plan.
Children's Health Insurance Program (CHIP) Notice – Notice of Eligibility for State Premium Assistance: Notice must be provided annually to employees who reside in a state that offers a premium assistance program under Medicaid or CHIP.
Medicare Part D Notice of Creditable Coverage: Notice is due before October 15 and may be sent with open enrollment materials. The notice must be provided to individuals enrolled or seeking to enroll in the plan who are eligible for coverage under Medicare Part D. Since it is often difficult to identify who is eligible for Medicare Part D, many employers provide the notice to all persons covered under the plan.
Women's Health & Cancer Rights Act (WHCRA) Notice: Notice regarding benefits for mastectomy-related reconstructive surgery and related conditions must be provided to participants annually.
Summary of Benefits and Coverage (SBC): Notice must be provided to individuals enrolled in the plan under several circumstances, including with initial and annual enrollment materials.
Wellness Program Notices – HIPAA requires that information about alternative standards available for receiving health-related rewards be included in any plan materials, describing the terms of the wellness program. The Americans with Disabilities Act (ADA) generally requires distribution of a notice about the collection and use of medical information in connection with a wellness program before such information is collected or any medical examination is conducted (and with enough time for the employee to decide whether to participate in the program).
HIPAA Notice of Privacy Practices: Notice must be provided to individuals covered under a group health plan at the time of enrollment in the plan, and availability of the privacy notice (or a full copy of the privacy notice) must be provided at least once every three years thereafter. Many plan sponsors will incorporate the HIPAA privacy notice (or information about its availability) into their annual open enrollment materials to facilitate compliance.

There are model documents and templates available for many of these required notices, but often these will need to be customized to reflect the particular design and administrative process for the relevant plan. Plan sponsors should also consider applicable state law notice obligations. For example, under the Illinois Consumer Coverage Disclosure Act, employers must notify employees about which essential health benefits are and are not covered under the employer-sponsored health plan.

Instant Insights /

Navigating open enrollment notice requirements

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