This Email Alert is the fourth in a series of reminders Nukk-Freeman & Cerra will be sending regarding the new healthcare law, known as the Patient Protection and Affordable Care Act (the "Affordable Care Act").
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PATIENT PROTECTION AND AFFORDABLE CARE ACT
NEW HEALTH PLAN NOTICE REQUIREMENTS
Under the Affordable Care Act, group health plans are required to provide certain notices to participants for plan years beginning on or after September 23, 2010 (January 1, 2011 for calendar year plans). The following summary describes these required notices. For calendar year plans, it may be advisable to include them in the open enrollment materials currently being distributed. In any event, such notices must be provided to participants before the first day of the plan year beginning on or after September 23, 2010 (the "2011 Plan Year").
Special Enrollment Notice for Adult Children
Under the Affordable Care Act, group health plans that offer dependent coverage must make that coverage available to children of eligible employees up to age 26 no later than the first day of the 2011 Plan Year. As a result of this requirement, notice must be provided to children who become eligible to participate in the plan and these children must be given a special enrollment opportunity of at least 30 days. The notice may be included in other materials distributed during open enrollment but the notice is required by the Department of Labor to be "prominent" (presumably by bolding, font size, etc.)Please note that if a health plan is "grandfathered" and the employer has elected to limit enrollment of adult children to those who do not have any other employer-sponsored coverage through their employer or their spouse's employer, the notice should include a statement reflecting this limitation.
Notice Regarding No Lifetime Limit
and Special Enrollment Opportunity
Under the Affordable Care Act, a group health plan must provide notice that any lifetime dollar limit for "essential benefits" no longer applies and any individual who previously lost coverage due to such limit must be given a special enrollment opportunity of at least 30 days. Like the notice regarding adult children, the notice must be "prominent", and the notice and special enrollment opportunity must be provided no later than the first day of the 2011 Plan Year. This requirement affects both grandfathered and non-grandfathered plans.
Notice of Grandfathered Status
As a condition for maintaining grandfathered status under the Affordable Care Act, a group health plan must include a statement in any plan materials distributed to participants and beneficiaries describing those plan benefits that the plan believes are"grandfathered." Additionally, the statement must provide contact information for employees with questions. This notice should be included in the open enrollment materials as well as other information distributed to participants (such as summary plan descriptions).Patient Protection Disclosure
Non-grandfathered plans that require or allow the designation of a primary care provider must notify participants of their right to (1) choose a primary care physician or pediatrician, and (2) obtain an OB/GYN without pre-authorization. This notice must be provided whenever a participant is provided with a summary plan description or other description of benefits. It can be included in open enrollment materials and must be provided no later than the first day of the 2011 Plan Year. Department of Labor Provides Model Language
Please note that the Department of Labor has provided model notice language for all of these notices on its website, www.dol.gov/ebsa. We would recommend that the model language be reviewed to make sure it is consistent with your plan, and, where applicable, make any necessary changes before distributing the notice to participants.Nukk-Freeman & Cerra is available to discuss these notices and help you determine which notices apply to your particular plan. In addition we are available to discuss any other aspect of the Affordable Care Act, such as determining if your plan is grandfathered. Please feel free to contact Liza Hecht (lhecht@nfclegal.com), Christine Gottesman (cgottesman@nfclegal.com) or the Nukk-Freeman & Cerra attorney with whom you work to discuss this important compliance matter, or if you have any questions regarding the Affordable Care Act.Any tax advice included in this written or electronic communication was not intended or written to be used, and it cannot be used by the taxpayer, for the purpose of avoiding any penalties that may be imposed on the taxpayer by any governmental taxing authority or agency.
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