Employee Benefit Plan Notices

At times it feels like the Affordable Care Act (ACA) has monopolized our time and energy when it comes to employee benefits compliance. However, it is important to remember that although ERISA and other federal benefits statutes were amended by the ACA, they also contain several other independent obligations. So while we all hold our breath waiting to see which (if any) of the ACA’s provisions will survive President Trump’s inaugural executive order, it’s a good time to revisit the ongoing notice requirements for group health plans:

ACA Notice Requirements (still in place as of 4/1/2017)

  • Summary of Benefits and Coverage (SBC)—summary of plan benefits to be included in the plan’s open enrollment materials using a template provided by federal agencies. Note that a new template will be used for plan years beginning on or after 4/1/2017. Any mid-year modifications to the information contained in the SBC should be provided no later than 60 days prior to the change’s effective date.
  • Form 1095-C—applicable large employers need to provide full-time employees with a Form 1095-C documenting offers of group health coverage for the 2016 calendar year. Forms are due to employees no later than March 2, 2017. Copies of Forms 1095-C must also be submitted to the IRS by February 28, 2017 (if filing paper copies) or March 31, 2017 for electronic submissions.
  • Form 1095-B—form provided to all individuals enrolled in coverage. Insurance carriers will provide for fully insured plans, but small employers with self-insured plans will need to issue Form 1095-B to each enrolled employee (or other responsible individual).
  • Grandfathered Notice (if applicable)—any plan retaining grandfather status must include a disclosure with any communications describing plan benefits. Model Notice
  • Patient Protection Notice-Choice of Provider (if applicable)—non-grandfathered plans that require designation of primary care physician, must notify participants of the right to choose a network provider that may include a pediatrician or OB/Gyn.
  • Notice of Rescission (if applicable)—notice must be issued prior to any retroactive termination of coverage due to fraud or intentional misrepresentation by a participant.

With the constantly changing regulatory environment, compliance for employer-sponsored health plans is more important than ever. Please contact your account representation or compliance@jwterrill.com if you need assistance.

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About Dawn Kramer

Dawn is an attorney and Certified Employee Benefit Specialist (CEBS) in J.W. Terrill’s Consulting Services department. She advises clients on legal and regulatory issues affecting their employee benefit plans.

View all posts by Dawn Kramer

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