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.

• Special HIPAA Enrollment Rights Notice
• Children's Health Insurance Program Model Notice

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

Special HIPAA Enrollment Rights

Group health plans are required to provide a notice of special HIPAA enrollment rights to all participants and beneficiaries on or before the time they are offered the opportunity to enroll in a group health plan.  A special enrollment opportunity occurs if an individual with other health insurance loses that coverage or if a person becomes a new dependant through marriage, birth, adoption or placement for adoption.  DOL has published a model notice that may be used:

Click here for Special HIPAA Enrollment Rights Model Notice (Appendix D)

Children's Health Insurance Program Reauthorization Act ("CHIPRA")

The initial CHIPRA Notice must be provided by the first plan year after February 4, 2010.  The CHIPRA notice describes the special enrollment opportunity available when an employee's or dependent's Medicaid or SCHIP coverage terminated or when an employee or dependent becomes eligible for a premium assistance subsidy under Medicaid or CHIP. The DOL and HHS have recently issued an updated model CHIP Notice on November 2, 2010.

Click here for CHIPRA Model Notice

Click here for CHIPRA Fact Sheet

Further Compliance Information and Resources

Mental Health Parity and Addition Equity Act of 2008 ("MHPAEA")

The MHPAEA interim final rules are applicable for plan years that begin on or after July 1, 2010. MHPAEA substantially changes prior rules and creates parity for mental health and substance abuse benefits. The new requirements affected group health plans with 51 or more employees in the prior calendar year. Plans need to be reviewed to ensure compliance with new rules.

Click here for Mental Health Parity Fact Sheet 

HIPAA Privacy Notice

The HIPAA Privacy Notice must be updated to include changes for Genetic Information Nondiscrimination Act ("GINA") and the Health Information Technology for Economic and Clinical Health Act of 2009 ("HITECH"). The HHS has issued proposed HITECH regulations, but has not finalized them. The proposed regulations impose additional requirements that need to be included in the Notice of Privacy Practices. HHS has indicated that covered entities will generally be given 180 days after the final regulations are issued to comply with the new rules. These updated notices much be provided to new enrollees at the time of enrollment and to enrollees covered by the plan within 60 days of material revision. Individuals covered by the plan must also be notified at least once every three years on the availability of and how to obtain the notice.

Click here for the HIPAA Fact Sheet

Women's Health and Cancer Rights Act ("WHCRA")

Notice must be provided to all participants upon enrollment and annually thereafter.  This notice informs participants and beneficiaries who are receiving mastectomy-related benefits that coverage will be provided for reconstructive surgery in a manner determined in consultation with the attending physician and the patient.  Coverage includes reconstruction of the bread on which the mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, prostheses and treatment of physical complications at all stages of mastectomy, including lymphedemas.

Click here for WHCRA Fact Sheet

Newborns' and Mothers' Health Protection Act ("NMHPA")

Notice must be provided in an SPD or SMM to all participants.  This notice must include a statement describing any requirements under federal and state law applicable to the plan or the health insurance offered under the plan, relating to any hospital length of stay in connection with the childbirth for a mother of newborn child.

Click here for NMHPA Fact Sheet