Important Healthcare Reform and Compliance Notices

The new year is right around the corner and for Health plans

effective January 1, 2011 employers will have to deal with participant notices required under the new rules.

• Extended Dependent Coverage and Enrollment Notice
• Lifetime Limits Elimination and Enrollment Notice
• Advance Notice of Rescission
• Provider Choice

 Below are brief explanations of the new rules and notice requirements for 2011.

Extended Dependent Coverage and Enrollment Notice

Plans that offer dependent coverage are now required to provide a notice informing participants that their children's coverage can continue until their 26th birthday.  Plans are also required to offer a 30-day period to enroll eligible children who lost or were denied coverage because of a lower plan limit.

Plans may choose to extend coverage beyond the child's 26th birthday (end of year or month in which the child turns 26).  

For plan years effective January 1, 2011, the notice and enrollment period must be provided no later than January 1, 2011 and the enrollment will be effective as of that date.  The notice should be included with other enrollment materials.

Click here for Extended Dependent Coverage and Enrollment Model Notice

Lifetime Limits Elimination and Enrollment Notice

If a plan participant lost coverage upon reachinig a plan's lifetime limit, the Plan is required to provide notice of the elimination of the lifetime doollar limits.  The Plan is required to offer a 30-day special enrollment opportunity to those affected by the loss of coverage.

For plan years effective January 1, 2011, the notice and enrollment period must be provided no later than January 1, 2011 and the enrollment will be effective as of that date.  The notice should be included with other enrollment materials. 

Click here for Lifetime Limits Elimination and Enrollment Model Notice 

Advance Notice of Rescission

Although to date there is no model notice for this requirement, it is important to summarize this new rule.

If the Plan retroactively terminates an individual's coverage because of deliberate fraud or intentional misrepresentation, the plan must give the affected individual at least 30 days advanced notice.

Provider Choice (applies only to non-grandfathered plans)

If the Plan requires designation of a primary care provider they must inform participants of their right to choose a primary care provider and to obtain obstetrical or gynecological care without prior authorization.

For plan years effective January 1, 2011, the notice must be provided no later than January 1, 2011.  The notice must be incorporated into the Plan's summary plan description or provided as a separate notice with the summary plan description.

Click here for Provider Choice Model Notice