When we talk about annual notices, we’re talking about certain specific notices that must be distributed to employees at least 30 days before an employer health plan renews. When an employer is acting as a plan sponsor, they are responsible for ensuring that annual notices are distributed. These are separate from things like plan documents or Medicare Part D creditability notices (which also need to be distributed, but with different timeline requirements).
Annual notices include:
- HIPAA Special Enrollment Notice
- HIPAA Notice of Privacy Practices
- CHIP
- WHCRA
- NMHPA
- SBC
- Grandfathered Status (if applicable)
- Primary Care Physician Designation (if applicable)
- Wellness Program Notices (if applicable)
Many of these notices are subject to certain elements of your plan, meaning you may not need to send every notice to every employee. Some notices are only required when the employee initially enrolls, while others are required at each open enrollment.
As the plan sponsor, you’re responsible for ensuring these notices are correct and distributed properly. However, if you have a fully-insured plan, your carrier may send some of these on your behalf. If that’s the case, contact your carrier to coordinate distribution.
Annual notices are important, so federal guidelines govern how they’re distributed. They must be provided in a way “reasonably calculated to ensure actual receipt;” simply placing the notices in an easily accessible location isn’t enough. Notices should be delivered by mail or email—though there are a lot of specific requirements that must be met before electronic disclosures are allowed.
HIPAA Special Enrollment Notice
This notice provides information about various HIPAA qualifying events that provide employees with a right to enroll in the plan mid-year. While it may be a good idea to provide additional employee education on what qualifying events are and how they do—and don’t—work, this is the official notice that must be distributed.
Because all health plans are subject to these HIPAA mid-year enrollment rights, all health plans must distribute this. Send this notice to all health plan eligible employees prior to initial enrollment. There’s no need to send this out to everyone annually, though you certainly can if you want to simplify your process.
HIPAA Notice of Privacy Practices
Essentially, this notice briefly explains a plan participant’s HIPAA rights and details how your health plan handles their protected health information. If you are sponsoring a fully insured plan that doesn’t access PHI, the carrier is generally the one to send this notice out.
This goes out to all plan participants at initial enrollment, though you also need to distribute if material changes are made in the way you handle PHI. You’ll also need to send out a reminder that the notice is available every 3 years. As with the Special Enrollment notice, you can include this notice every year if you prefer to simplify your compliance tracking.
Children’s Health Insurance Program (CHIP)
CHIP is a Medicaid-based program that offers free or low-cost health coverage to children and their families. The notice provides your employees with information about CHIP, and explains that they may be eligible for premium assistance through CHIP or Medicaid.
This notice must be distributed by all plans every year to any employees who live in the states listed in the notice, which is about ¾ of the United States. If you have employees in many different states, it may be simpler to distribute to all employees regardless of whether the notice applies. Your carrier may distribute this for you, but make sure that you check with them before leaving this out.
Women’s Health & Cancer Rights Act Notice (WHCRA) & Newborns’ and Mothers’ Health Protection Act Notice (NMHPA)
These two notices are often handled together because they are closely linked. The WHCRA notice informs employees about benefits in connection with a mastectomy and related procedures. The NMHPA notice explains hospitalization requirements for newborns and mothers at both the state and federal levels.
This plan needs to be distributed by all plans to all plan participants every year. Your carrier may distribute this for you, but make sure that you check with them before leaving this out.
SBC: Summary of Benefits and Coverage (SBC) and Uniform Glossary
An SBC is precisely what it sounds like: a summarized version of the plan’s benefits. It gives employees an overview of the plan in a Q&A format, with examples and resources for other languages. While the SBC does describe some parts of your plan, an SBC cannot replace required ERISA plan documents.
All plan sponsors must distribute the SBC every year, and this goes out to everyone—including eligible employees, retirees, and COBRA participants. Your carrier or TPA should assist you in preparing an SBC, but as the plan sponsor, you are responsible for ensuring that it’s distributed correctly.
Notice of Intent to Maintain Grandfathered Status
The ACA set various rules and standards that health plans must follow, but some health plans were grandfathered in. If your health plan intends to maintain that grandfathered status—which exempts you from some of the ACA’s requirements—you must distribute a notice stating that.
Fewer and fewer health plans maintain their grandfathered status, which means it’s becoming less and less likely that this notice applies to your plan. But if it does, you must distribute it to all participants each year.
Notice Regarding Primary Care Physician Designation
This notice informs plan participants that they must designate a primary care provider. This is most common in an HMO plan, where specialists require a referral from the primary care physician.
Most plans don’t have this requirement, so there’s a good chance that this notice doesn’t apply to your plan. But if it does, you must distribute the notice to all plan participants. Your carrier may distribute this for you, so coordinate with them to ensure proper distribution.
Wellness Program Notices
There are two types of wellness program notices that you may be required to send out. If your wellness program is “health contingent” (meaning participants must satisfy certain health standards like biometric screenings or smoking cessation to earn a reward), HIPAA requires a disclaimer to inform your wellness plan participants that they can satisfy an alternate standard if they are medically unable to meet the wellness program’s requirements.
If your wellness program collects participant health information (biometric screenings, medical questionnaires, etc.), you need to distribute an ADA notice that addresses how you plan to use and protect this information. Wellness plan participants need to receive this notice before giving any health information, with plenty of time for them to decide whether or not to participate.
Obviously, neither of these is required if your plan doesn’t include a wellness program that has a health contingent component and/or collects health information. If you do have a wellness program that meets one or both criteria, you need to distribute the corresponding notices to all eligible employees along with any information regarding the wellness program.
