Since the majority of health plans go through open enrollment during the 4th quarter, it is a good idea to review which notices should be included in enrollment materials and which should be left out.
Here are the notices an employer plan sponsor should include in the open enrollment guide:
Summary of Benefits and Coverage (SBC)
Employer CHIP Notice
Women’s Health and Cancer Rights Act (WHCRA) Annual Notice
Wellness Program Notices (under HIPAA, GINA or the ADA, if applicable)
Medicare Part D Creditable or Non-creditable Coverage Notice – must be sent before 10/15, but should also be included in enrollment materials.
Notice of HIPAA Special Enrollment Rights
Exchange Notice – but keep in mind this has to be given within 14 days of hire, including full-time AND part-time employees.
Notice of Privacy Practices (in some cases) *
Summary of Material Modifications (including material reductions) *
*Fully-insured group health plans that don’t create or receive protected health information (PHI), other than summary health and enrollment/dis-enrollment information, don’t have to give this notice. However, fully-insured plans that create or receive PHI must keep the notice and provide it to any person upon request. Or easier, they can just give it out.
**Employers who communicate material changes for the coming year in open enrollment materials should include language to notify participants that it also constitutes an SMM. This can be an effective way of letting participants know about the changes while satisfying the SMM requirement.
In contrast, there are two notices that might be better left out of open enrollment materials. The first is the COBRA Initial Notice because it must be given to enrolled employees and spouses within 90 days of plan participation, preferably sent via first-class mail. Similarly, the SPD must be given within 90 days of plan enrollment, but it can be provided earlier if it helps employees make more informed decisions.