Annual Notices For Your Group Health Plan: Compliance For Employers

A number of disclosures and annual notices are required by law if you offer a group health plan. And while keeping up with required notices can be confusing and time consuming, if you fail to provide them, you could face steep penalties. Not sure what you have to provide your workers? Here, we’ll break it down for you.

In this article, we’ll explain the notices rules you need to follow to stay compliant with employment laws and regulations and steps to take to avoid violations. After reading this, you’ll know what you need to do to make sure you distribute the necessary annual notices to participants to protect your employees and your business.

Top Group Health Plan Disclosures and Annual Notices

Employers who offer group health plans are required to distribute several different annual notices to maintain compliance. Here are the most common rules you need to follow.

ACA Notices

• Requirement: Under the Affordable Care Act (ACA), you’ll need to provide certain notices for your group health plan. These include an Exchange Notice that advises employees about the ACA’s health insurance marketplace and a Notice of Patient Protections that contains their rights to choose a primary care provider and obtain OBGYN care without prior authorization.
• Due Date: The Exchange Notice is due upon hiring a new employee within 14 days of their start date. The Notice of Patient Protections must be provided whenever the plan provides a participant with a Summary Plan Description or other similar description of benefits under the plan.  

ERISA Notices

• Requirement: Under Title 1 of ERISA, administrators of employee benefit plans have several ERISA notice requirements they’ll need to meet. The notices you’ll need to provide to participants, beneficiaries, and certain other individuals include:
  •  Summary Plan Description (SPD)
    • Requirement: You must provide an SPD to participants that details everything about your group health plan like eligibility requirements, benefits, claims, appeals procedures, enrollment rights, and rights under ERISA.
    • Due Date: You need to furnish the SPD within 90 days of participants getting coverage or within 30 days of a participant’s written request. An updated SPD must be furnished every 5 years if changes are made to SPD information or the plan is amended (otherwise, it must be furnished every 10 years).

• • Plan Document or Wrap Document 
    • Requirement: Your plan must be established and maintained
      pursuant to a written plan document. It doesn’t need to be in any
      particular format but must include information on the rights of plan participants as well as the plan’s operation and administration.One common approach to plan documents is to create a summary wrap document, which is one document that “wraps around” all the covered benefits you offer.
    • Due Date: The plan document doesn’t need to be furnished to employees. However, if an employee requests a copy, you must provide it within 30 days of their written request.

HIPAA Notice of Privacy Practices

• • Requirement: To comply with HIPAA, you must issue a Notice of Privacy Practices that gives employees a clear explanation of their rights with respect to their health information as well as your privacy practices. However, plan sponsors of fully insured health plans that don’t create or receive health information other than summary or enrollment information aren’t required to comply with the Privacy Notice requirement.
  • Due Date: You’ll need to provide this notice at the time of enrollment or when a participant requests it. You’ll also have to furnish it to employees within 60 days of a material revision.

COBRA Notices

• • Requirement: Once an employee experiences a COBRA qualifying event, you’re required to provide certain notices to qualified beneficiaries of their COBRA rights. The two most common notices are the Election Notice and General Notice. 
  • Due Date: Each notice has specific timeframes in which they must be issued. The Election Notice is due within 14 days of learning of a qualifying event and the General Notice must be provided to the employee or covered spouse within the first 90 days of coverage.

Additional Benefit Notices

In addition to the requirements listed for the laws we’ve already discussed, there are additional annual notices for group health plans you must provide to share important information about coverage and beneficiaries’ rights and responsibilities. 

Genetic Information Nondiscrimination Act (GINA) Disclosures

• Requirement: If you have 15 or more employees, GINA applies to you and prohibits discrimination based on an individual’s genetic information. While GINA doesn’t require that you provide a written notice to employees, many employers opt to do so in order to make clear what is required and permitted with regard to obtaining and maintaining genetic information. At a minimum, you should include safe harbor language in any forms that are used for processing medical or leave requests.
• Due Date: This notice must be provided whenever an applicant or employee is sent for a medical examination by an employer with 15 or more employees. An additional “warning” is required when requests for health-related information are made by employers with 15 or more employees (e.g., to support an employee’s request for reasonable accommodation or a request for sick leave), but only if the request for medical documentation is made in a way that is likely to result in receipt of genetic information. 

Children’s Health Insurance Program Reauthorization Act (CHIPRA) Notice

• Requirement: If you provide a group health plan in a state that provides premium assistance through employer-based plans, you’ll need to provide an annual CHIP notice to let employees know of the opportunities available. A model notice is available from the DOL.
• Due Date: The CHIP notice must be provided annually before the start of each plan year (may be provided with enrollment packets, open enrollment materials, or the SPD).

Michelle’s Law Notice

• Requirement: If your group health plan provides dependent coverage beyond age 26 and bases eligibility for such coverage on student status, you’ll need to provide a notice along with any notice regarding a requirement for certification of student status for coverage under the plan.
• Due Date: The notice must be provided any time a request for student status is requested by the plan. 

Mental Health Parity and Addiction Equity Act Disclosure

• Requirement: You need to provide a notice to employees that the financial requirements and treatment limits that apply to mental health or substance use benefits under your plan are no more restrictive than for other medical benefits.
• Due Date: You’ll need to provide this notice upon request for a plan offering medical/surgical benefits and mental health or substance use disorder benefits.

Women’sHealth and Cancer Rights Act Notice

• Requirement: Unless you are exempt because you have fewer than 2 participants who are current employees, you’ll need to provide a notice to advise employees about benefits that may be available to them if they’re having a mastectomy.
• Due Date: You’ll need to provide the notice of rights both upon enrollment and annually thereafter. 

Newborns’ and Mothers’ Health Protection Act Notice

• Requirement: You need to provide a notice to employees explaining that your plan can’t restrict a hospital stay in connection with childbirth to less than 48 hours for a vaginal delivery or 96 hours following a C-section.
• Due Date: This notice must be included in the SPD for a plan providing maternity or newborn infant coverage.  

Uniformed ServicesEmployment and Reemployment Rights Act (USERRA) Notice

• Requirement: You need to provide a notice to employees that their job rights are protected if they voluntarily or involuntarily leave employment for military service or for certain types of service in the National Disaster Medical System.
• Due Date: You’ll need to provide the notice of rights at time of new hire enrollment and annually thereafter.

Medicare Part D Notice of Creditable Coverage

• Requirement: If you offer prescription drug coverage to employees who are eligible for Medicare Part D coverage, you have to provide a notice about your drug coverage to help them compare their options.
• Due Date: This notice is due before Medicare Part D’s annual election period each year that runs from October 15 to December 7, upon request, and at various other times as required under the law.

How to Stay Compliant with Annual Notices For Group Health Plans

As you can see, there are a number of annual notices and disclosures you’ll need to provide to specific individuals at specific times when you offer a group health plan, which can be challenging to keep track of on your own. To stay compliant and ease the administrative burden of notices, many companies lean on an insurance broker or third-party administrator to help. If you’re thinking about going this route and want to know about the compliance assistance Complete Payroll Solutions offers, read our next article on our brokerage services. 

Editor's Note: This blog was originally published in July of 2021 and was updated in March of 2023 for accuracy.