When I meet potential clients, I ask if they provide the 12 required government health insurance notices or documents and I receive a blank stare or the owners say yes. When I review each notice with them, they are missing at least 80% of them. Business- es that do not provide the notices are risking major fines from governmental agencies that could reach $1.5 million from the Office of Civil Rights for HIPAA privacy violations. The Depart- ment of Labor’s (DOL) fines start at $5,000 and can reach over $250,000.
The following is a list of notices that must be provided to all benefits eligible employees who enroll on your health plans. In addition, notices 1 & 3 have to go to all employees that are not benefits eligible.
- Health Insurance Exchange Notice
- With the passage of the Affordable Care Act 10 years ago, this is an annual required notice.
- Notice of Special Enrollment Rights
- Employees that enroll on your health plans must receive this notice each year that states that employees cannot change plans until open enrollment unless they is an IRS qualifying event.
- Notice of Privacy Practices
- Since employees provide confidential non-public private information (NPPI) and protected health, information (PHI) employers must outline their privacy practices with this notice annually.
- Mental Health Parity and Addiction Equity Act (MHPAEA) Dis- closure (for companies with 50 or more employees)
- Since 2008, the MHPAEA must be given to employees that states mental health benefits cannot be more restrictive than all medical/surgical benefits.
- Employer’s Children’s Health Insurance Program (CHIP) Notice
- The CHIP notice states that children may be eligible for Medicaid/Medi-Cal with links to websites and phone numbers in participating states
- Newborns’ and Mothers’ Health Protection Act Notice
- Group health plans may not restrict benefits for childbirth or newborn childcare and this notice outlines timelines for hospitals for normal and C-section deliveries.
- Medicare Part D Creditable Coverage Notice
- This notice that must be provided before October 15 each year states whether the drug coverage the employee has is equal to or better than Medicare Part D coverage.
- Employers also have to log into the CMS website and report the information.
- Genetic Information Nondiscrimination Act (GINA) Disclosures (for companies with 15 or more employees)?
- This act protects employees against discrimination based on genetic information and employers may not request or require any genetic information from employees or family members.
- General Notice of COBRA Rights (for companies with 20 or more employees)
- The COBRA Rights notice outlines continuation health coverage if the employee leaves an employer.
- If an employer uses a third party to administer COBRA those services may not include this notice that is required when an employee enrolls in a company’s health plan.
- USERRA Notice
- USERRA protects the job rights of employees who leave for military service and governs employer provided health insurance
- FMLA Notice (for companies with 50 or more employees)
- Provides employees with their family & medical leave rights
- Summary Plan Description (SPD)
- If the DOL conducts a benefits audit, the first thing they ask for is your SPD.
- My experience is that 80% of companies do not provide SPDs to their employees.
- The SPD is not provided by insurance carriers and is the employer’s responsibility.
If you are not providing these notices you are with the wrong health insurance agent or broker.