Open enrollment is right around the corner (at least for employers that run calendar-year health benefit plans), so many employers will be updating their benefit communication plans. Though not comprehensive, the following is a list of required and relevant notices that employers who sponsor such plans must commonly provide to employees who participate.

Annual Notices Required and Recommended

Agencies that regulate health plans regularly introduce new requirements for annual notices. The Department of Labor provides samples of many of the following in its Compliance Assistance Guide.

• • Medicare Part D Notice of Creditable/Non-Creditable Coverage: due October 15, 2024. The Biden administration’s Inflation Reduction Act made several modifications to previous years’ notices. This may put the creditable status of many employer plans in jeopardy starting in 2025. Many employers observe a best practice to work with their insurance carrier, TPA, or broker/consultant to determine their plan’s creditable status for the coming year. Mandatory annual disclosure.
  • Summary of Benefits and Coverage (SBC): standard template notice that must be provided to all group health plan applicants and enrollees; best practice is to provide it annually at open enrollment. The Employee Benefits Security Administration provides a model template here. Mandatory annual disclosure.
  • Children’s Health Insurance Program (CHIP) Notice: annual notice requirement to inform employees they may be eligible for premium assistance through CHIP or Medicaid. Mandatory annual disclosure.
  • Women’s Health and Cancer Rights Act (WHCRA) Notice: must be provided upon enrollment and annually thereafter to inform employees of the availability of coverage for reconstructive surgery following a mastectomy. A sample notice may be found here on pages 141-142. Mandatory annual disclosure.
  • HIPAA Special Enrollment Notice: must be provided when giving employees their initial opportunity to enroll in your health plan; best practice is to provide it annually. A sample notice is found here on page 138.
  • Primary Care Provider Patient Protection Notice (for plans that require the designation of a PCP, such as an HMO plan): must be provided whenever a Summary Plan Description or similar description of benefits is provided; best practice is to provide it annually.
  • ADA Wellness Program Notice (if a wellness plan includes medical exams or medical questionnaires): must be provided to employees before they release any health information, with enough time to decide whether to participate; best practice is to circulate it annually.
  • Newborns’ and Mothers’ Health Protection Act Notice: must be included in the health plan’s Summary Plan Description. Sample language may be found here on page 140.
  • ACA Exchange Notice (sometimes referred to as “Marketplace Notice”): must be provided to all new hires within 14 days of employment; best practice would be to include this in standard new-hire packets. See “Model Notice for employers who offer a health plan to some or all employees (updated February 2024)” here.
  • HIPAA Notice of Privacy Practices (for self-insured health plans): must be provided by employers upon enrollment and within 60 days of any material changes to the notice, and must also be furnished at least once every three years.
  • Initial COBRA Notice: must be given to employees and spouses within 90 days of initial enrollment; best practice is to include this in standard new-hire packets.
  • Notice Regarding Patient Protections Against Surprise Billing: The ACA requires all employers who sponsor a self-funded, non-grandfathered medical plan to post links to machine-readable files that contain transparency-in-coverage-cost information—if they maintain a public website for the group health plan. If the employer does not have a public group health plan website, it should make certain the insurance carrier or third-party administrator makes the notice available on their website.
  • Summary Plan Description: must be provided to new health plan participants within 90 days and updated and redistributed every 5 years if benefits have changed—otherwise, every 10 years.
  • Grandfathered Plan Notice: If the employer has maintained a grandfathered plan, this notice must be included in the SPD and “any plan materials provided to a participant describing the benefits under the plan” (such as open enrollment materials).

Affordable Care Act

• • Employers that have hovered around fifty (50) full-time employees, including full-time-equivalents, will likely want to determine whether they will qualify as an Applicable Large Employer in 2024, and therefore have to provide health coverage in 2025 under the ACA’s employer-shared responsibility provisions (sometimes referred to as the “Employer Mandate” or “Pay or Play”).
  • Applicable Large Employers and employers of any size offering a self-insured health plan (including level-funded plans) are required to generate Forms 1094-C and 1095-C (1094-B and 1095-B in the case of self-insured plans) and provide them to employees no later than March 3, 2025, and file them with the IRS by March 31, 2025. Forms must be filed electronically.
  • Employers are reminded that the ACA’s new health plan resets the affordability threshold for Applicable Large Employers to offer at least one affordable, minimum-value health plan. See our previous article regarding this change here.

Maximum Deductibles and Cost Sharing

• • Group health plans that are not designated high-deductible health plans (HDHPs) must limit annual out-of-pocket maximums for essential health benefits (EHB) to $9,200 for a single enrollee and $18,400 per family. This is a slight decrease from 2024 maximums.
  • HDHPs must have a minimum deductible of $1,650 for a single enrollee and $3,300 per family. The HDHP out-of-pocket maximum may not exceed $8,300 for a single enrollee, and $16,600 per family.
  • Individuals with an HDHP may contribute $4,300 toward an employee-only Health Savings Account (HSA). A family may contribute $8,550. Individuals age 55 and over may increase their contribution by $1,000.
  • Flexible Spending Accounts: Next year’s flexible spending account limits have not yet been released. They generally come out the first week of November.

This Compliance Checklist is not exhaustive, nor should it be construed as legal advice. Each employer’s situation is unique. If you are unsure about your health plan compliance responsibilities, you should contact legal counsel.

This article summarizes aspects of the law and does not constitute legal advice. For legal advice with regard to your situation, you should contact an attorney.