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LEGISLATION & REGULATIONS
NEW!!! (with details and information coming soon)
AMERICANS WITH DISABILITIES ACT AMENDED ACT EXPANDED -- Effective January 1, 2008 for military provisions w/final dates forthcoming.
FAMILY AND MEDICAL LEAVE ACT -- Effective January 1, 2010. Two new types of leave added.
GINA -- Effective January 1, 2010 for calendar year plans.
HEART ACT -- Effective for plans years beginning after December 31, 2008.
MEDICARE SECONDARY PAYER REPORTING REQUIREMENTS -- Effective January 1, 2009 w/data inputby Med-Pay as of April 1, 2009.
Mental Health Parity and Addiction Equity Act of 2008 -- Effective for plan years
beginning on or after October 1, 2009.
MICHELLE'S LAW -- Effective for plan years beginning on or after October 9, 2009.
Newborn and Mothers, Health Protection Act 2008 -- Effective for plan years beginning on or after January 1, 2009.
NOTICE OF PRIVACY PRACTICES (NPP) FOR PROTECTED HEALTH INFORMATION PER HIPAA
DESCRIPTION: Notice to participants describing their rights, the plan's legal duties with respect to protected health information and the plan's uses and disclosures of protected health information.
DISTRIBUTION: Plan Administrator to participants.
DUE DATE: Provide to participants at enrollment and within 60 days of a material revision to the notice. Every 3 years the plan must notify all individuals covered by the plan that a NPP is available and how to obtain it.
NOTICE OF CREDITABLE COVERAGE FOR Rx BENEFITS
DESCRIPTION: For group health plans that provide Rx coverage to Medicare Part D eligible individuals (unless contracted with or become a Part D plan). Written notice stating whether or not the expected amount of paid claims under a group health plan's prescription drug coverage is at least as much as the expected amount of paid claims under the standard drug benefit under Medicare Part D. Model forms are available from CMS.
DISTRIBUTION: Plan to participants and beneficiaries eligible for Medicare Part D.
DUE DATE: The notice must be provided by: a) November 15 of each year; b) prior to an individual's initial enrollment period for Part D; c) prior to the effective date of coverage for any Part D eligible individual who enrolls in the employer's prescription drug coverage; d) when the plan no longer provides any drug coverage or when the coverage is no longer creditable; and e) upon request. Sending the notice to all plan participants annually satisfies the requirements of a and b.
CREDITABLE COVERAGE DISCLOSURE NOTICE TO CMS
Description: For group health plans that provide Rx coverage to Medicare Part D eligible individuals unless contracted with or become a Part D plan): Written disclosure to CMS via online form stating whether or not the expected amount of paid claims under a group health plan's prescription drug coverage is at least as much as the expected amount of paid claims under the standard drug benefit under Medicare Part D. Not applicable if plan contracts with or becomes a Part D plan.
Distribution: Plan to CMS.
Due Date: Within 60 days after the beginning of the plan year. Also, within 30 days of the termination of a plan's prescripton drug coverage or after a change in the creditable status of the plan. Plans approved for the Retiree Drug Subsidy (RDS) are exempt from providing the notice with respect to retirees for whom the plan is claiming the subsidy.
APPLICATION FOR RETIREE DRUG SUBSIDY (RDS) AND ATTESTATION OF ACTUARIAL EQUIVALENCE
Description: For group health plans that provide retiree drug coverage and are applying for the RDS under MMA 2003: Request for the RDS available to group health plans that have retiree drug coverage that is actuarially equivalent to Medicare Part D coverage. Subsidy is available for each retiree, spouse and dependent who is eligible for Medicare Part D but not enrolled in Medicare Part D. Application and attestation must be complete by deadline. List of retirees for whom the plan may receive a subsidy must also be submitted to complete application. Additional cost submissions are required to receive subsidy payment.
DISTRIBUTION: Plan Sponsor to CMS.
DUE DATE: The subsidy applications and attestation must be submitted annually, at least 90 days prior to the start of the plan year (e.g., for plan years beginning April 1, the new application and new attestation must be completed by January 1). Attestation must also be provided no later than 90 days before a material change to drug coverage that potentially causes the plan to no longer be actuarially equivalent.
PLAN DOCUMENT -- ERISA
DESCRIPTION: For all benefit plans subject to Title I of ERISA: Copies of plan and trust instruments, most recent annual report and any collective bargaining agreements, contracts or other instruments under which the plan is established or operated.
DISTRIBUTION: Plan Administrator to participants and beneficiaries.
DUE DATE: Plan Administrator must make available for inspection at the principal office of the administrator. Copies must be furnished within 30 days of a written request.
SUMMARY ANNUAL REPORT (SAR) -- ERISA
DESCRIPTION: For all benefit plans subject to Title I of ERISA. Exception: defined benefit plans subject to the new Annual Funding Notice for plan years beginning after 2007: Narrative summary of financial information reported on Form 5500 and statement of right to receive annual report.
DISTRIBUTION: Plan Administrator to participants and pension plan beneficiaries receiving benefits.
DUE DATE: Generally, the later of 9 months after the plan year ends; or, where an extension of time has been granted by the IRS, 2 months after the SAR is due. Model notices are provided in 29 CFR 2520.104b-10(d). Report must follow the model. Exemptions list at 29 CFR 2520.104b-10.
SUMMARY PLAN DESCRIPTION (SPD) -- ERISA
DESCRIPTION: For benefit plans subject to Title I of ERISA: Summary of plan provisions and certain standard language as required by ERISA.
DISTRIBUTION: Plan Administrator to participants, retirees and pension plan beneficiaries receiving benefits.
DUE DATE: Within 120 days after the plan's effective date. For amended plans: once every 5 years. For all other plans: once every 10 years. New participants must receive SPD within 90 days of becoming participants. Beneficiaries receiving benefits under a pension plan must receive within 90 days after first receiving benefits.
SUMMARY OF MATERIAL MODIFICATIONS (SMM) - ERISA
DESCRIPTION: For all benefit plans subject to Title I of ERISA: Summary of changes in any information required in SPD and certain items in discontinued EBS-1 Form.
DISTRIBUTION: Plan Administrator to retirees, pension plan beneficiaries receiving benefits and participants (including welfare plan participants) with certain exceptions for updates.
DUE DATE: Within 120 days after the end of plan year in which modification(s) is adopted unless revised SPD is distributed containing the modificaton. To new participants: within 90 days of becoming a participant.
SUMMARY OF MATERIAL REDUCTION IN COVERED SERVICES OR BENEFITS
DESCRIPTION: For group health plans subject to Title I of ERISA: Summary description of modification or change that would be considered by the average plan participants to be an important reduction in covered services or benefits.
DISTRIBUTION: Plan Administrator to participants.
DUE DATE: Not later than 60 days afer the adoption of the modfication or change; or at regular intervals of not more than 90 days (i.e., newsletter).
WOMEN'S HEALTH iAND CANCER RIGHTS ACT (WHCRA) NOTICES -- ERISA
DESCRIPTION: For group health plans that provide for mastectomy benefits: Description of benefits under WHCRA and any deductibles and coinsurance limits applicable to those benefits.
DISTRIBUTION: Plan Administrator to participants and beneficiaries.
DUE DATE: Upon enrollment in the plan and annually thereafter. Sample language for enrollment notice and annual notice is available at DOL website.
NOTICE OF CONTINUATION OF HEALTH COVERAGE UNDER COBRA -- ERISA
DESCRIPTION: For group health plans: Notice to participants and spouses upon initial enrollment of their right to continue self-paid health coverage; and notice to qualified beneficiaries after a qualifying event. Also, notice to COBRA participants of changes in premium, when applicable.
DISTRIBUTION: Plan Administrator to all affected participants and other qualified beneficiaries.
DUE DATE: General Notice (aka Initial Notice): within 90 days of when coverage begins per DOL proposed rule to participants and spouses only. Election Notice (aka Notice of Qualifying Event) to specific qualified beneficiary: within 14 days after plan administrator is notified of a qualifying event in relation to that QB. Where employer and plan administrator are the same, allowed up to 44 days after QE or loss of coverage to provide notice. Premium change notice: at least 1 month prior to its effective date.
NOTICE OF UNAVAILABILITY OF COBRA CONTINUATION COVERAGE
DESCRIPTION: For group health plans: Notice to qualified beneficiaries that have sent a qualifying event notice to the plan administrator of the reason(s) why he/she/they are not entitled to COBRA continuation coverage.
DISTRIBUTION: Plan Administrator to all affected qualified beneficiaries.
DUE DATE: Within the same timeframe that the plan administrator would have had to provide an election notice had the person been eligible for COBRA continuation coverage. (Generally, 14 days after receipt of notice of a QE; or where employer is also the administrator, 44 days after notice of QE is received.)
NOTICE OF TERMINATION OF COBRA CONTINUATION COVERAGE
DESCRIPTION: For group health plans: Notice to qualified beneficiaries that his/her/their COBRA coverage is terminating early (e.g., before the end of the maximum coverage period). Notice must state the reason for early termination, the date of termination and any rights that the QB may have under the plan or applicable law to elect alternative group or individual coverage, if available.
DISTRIBUTION: Plan Administrator to all affected qualified beneficiaires.
DUE DATE: As soon as practicable following the administrator's determination that continuation coverage shall terminate early. May be combined with a HIPAA Certificate of Creditable Coverage.
NOTICE OF INSUFFICIENT PAYMENT OF COBRA PREMIUMS
DESCRIPTION: For group health plans: Notice to qualified beneficiary that payment for COBRA continuation coverage was less than the correct amount (but not "significantly" less).
DISTRIBUTION: Plan Administrator to all affected qualified beneficiaries.
DUE DATE: Plan must provide a reasonable period of time to cure the deficiency before terminating COBRA coverage. A grace period of 30 days is considered reasonable.
HIPAA CERTIFICATE OF CREDITABLE COVERAGE -- ERISA
DESCRIPTION: For group health plans: Notice to former participants and covered dependents detailing the length of time during which they were covered under the plan.
DISTRIBUTION: Plan Administrator to all former participants and covered dependents.
DUE DATE: Upon loss of health coverage and no later than the deadline for providing the COBRA qualifying event notice/election notice. To an individual who ceases COBRA, within a reasonable time after the plan learns that COBRA has ceased. Certificate must be given upon request in a reasonable and prompt fashion if a request is made within 24 months after coverage ends. A model certificate is available on DOL's website.
NOTICE OF SPECIAL ENROLLMENT RIGHTS -- ERISA
DESCRIPTION: For group health plans: Notice to participants of HIPAA's special enrollment rights.
DISTRIBUTION: Plan Administrator to participants.
DUE DATE: On or before a participant is offered the opportunity to enroll in a group health plan. Model language is available at DOL's website.
GENERAL NOTICE OF PREEXISTING CONDITION EXCLUSION -- ERISA
DESCRIPTION: For group health plans: Written notice of the existence and terms of any preexisting condition exclusion and the rights of individuals to demonstrate creditable coverage, including the right of individuals to request a Certificate of Creditable Coverage from a prior health plan or health insurer. Also, a statement that the current plan will assist in obtaining a Certificate from any prior plan or insurer, if necessary.
DISTRIBUTION: Plan Administrator to participants and covered dependents where the plan contains a preexisting condition exclusion clause.
DUE DATE: With enrollment materials; or, if no enrollment materials are distributed, by the earliest date following a request for enrollment.
INDIVIDUAL NOTICE OF PERIOD OF PREEXISTING CONDITION EXCLUSION -- ERISA
DESCRIPTION: For group health plans: Written notice of determination regarding the length of preexisting condition exclusion period that applies to an individual, including the basis for the determination, an explanation of the opportunity to present additional evidence of creditable coverage, and the remaining preexisting condition exclusion period that will apply to the individual.
DUE DATE: Within a reasonable time following the receipt of a Certificate of Creditable Coverage.
NEWBORNS' AND MOTHERS' HEALTH PROTECTION ACT (NMHPA) --ERISA
DESCRIPTION: For group health plans that provide maternity or newborn infant coverage: Notice to participants in SPD that describes any requirements under both federal and state law regarding the minimum length of a hospital stay in connection with childbirth.
DISTRIBUTION: Plan Administrator to participants.
DUE DATE: Within SPD or SMM timeframe.
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