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Compliance Overview

Employers that sponsor group health plans should provide certain benefit notices in connection with their plan's Open Enrollment periods. Some need to be provided at open enrollment, such as the Summary of Benefits and Coverage (SBC).

Other notices, such as the Women's Health and Cancer Rights Act (WHCRA) and the Medicare Part D Notice, must be distributed to employees annually. Although these notices may be provided at different times throughout the year, most employers often choose to include them in employee open enrollment guides for administrative convenience.

Employers should also review their open enrollment materials to make sure they correctly reflect the terms, conditions and cost of coverage(s). Plan design changes can be communicated either through a Summary of Materials Modification (SMM) or updated Summary Plan Description (SPD)

Highlights of Open Enrollment Notices

  • Medicare Part D Notice

  • SBC

  • HIPAA Privacy Notice

  • WHCRA Notice

  • CHIP Notice

  • SPD (and SMM, if applicable)

  • Wellness Program Notices

  • Marketplace Notice

Want more information on SPD & SMM requirements?

The Employee Retirement Income Security Act (ERISA) requires plan administrators to give to participants and beneficiaries a Summary Plan Description (SPD) describing their rights, benefits, and responsibilities under the plan in understandable language. The SPD includes such information as:

  • Name and type of plan

  • Plan’s requirements regarding eligibility

  • Description of benefits and when participants have a right to those benefits

  • Statement that the plan is maintained pursuant to a collective bargaining agreement, if applicable

  • Statement about whether the plan is covered by termination insurance from the Pension Benefit Guaranty Corporation

  • Source of contributions to the plan and the methods used to calculate the amount of contributions

  • Provisions governing termination of the plan

  • Procedures regarding claims for benefits and remedies for disputing denied claims

  • Statement of rights available to plan participants under ERISA.

New employees must receive a copy of their plan sponsor’s latest Summary Plan Description within 90 days after becoming covered by the plan. Plan sponsors are not required to file the Summary Plan Description with the Department of Labor (DOL), although they are required to provide it to DOL upon request.

In addition to the Summary Plan Description, plan participants are entitled to receive a Summary of Material Modifications when there is a material modification in the terms of the plan or any change to the information in the Summary Plan Description. The Summary of Material Modifications must be written in a manner that the average participant can understand. The material must be furnished within 210 days after the close of the plan year in which the modification was made.

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