When your company offers a group health plan, there are several notices you are required to provide participants about their health benefits. Keep track of required notice requirements can be tedious and time consuming, especially with the new Obamacare requirements, particularly for small and medium size employers. However, non-compliance may result in fees and penalties.
To assist in properly administering your health benefits and remain consistent this year, here is a checklist with 11 reviews key health plan required under ERISA, HIPAA, COBRA and PPACA 
Note :. This article is an excerpt from our 2015 free resource health plan review requirements. If you want to download the full resource, click here
Checklist -. Health Plan Notices required for 2015
This section outlines 11 key opinion health plan required of most group health plans. In general, opinions are applicable to all types of group health plans including fully insured plans and self-insured health insurance group defined contribution health plans (eg Health repayment plans ). However, some of the requirements vary with the size of your business and the type of health benefits you offer
. 1. Notice of availability of insurance markets Health
Employers covered by FLSA must provide all employees a notice about the availability of exchanges of insurance of the affordable care Act (market places).
2. Plan Summary Description (SPD)
The SPD is the main vehicle to inform participants and beneficiaries on their rights and benefits under their employee benefit plans.
The SPD contains information about :. the basic rights and responsibilities under ERISA, eligibility, plan benefits and how to access the benefits
3. Plan Documents
the Plan documents describe how the health plan is established or operated. The documents often include the latest update SPD, the last form 5500, the Trust Agreement and other instruments under which the plan is established or operated.
4. Summary of Benefits and Coverage (SBC) and Uniform Glossary
Summary of Benefits and Coverage (SBC) is a document 4 standard pages describing the benefits of the health plan in simple terms. The uniform glossary provides definitions of terms related to the cover.
5. Summary of material modifications (SMM) and notice of change
A SMM must be provided to each participant covered by the scheme if:
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changes to health outcomes occurring at a time other than at renewal.
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a change to health benefits affect the content of the SBC.
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information is not reflected in the most recent SBC.
Tip :. notice must be provided to participants at least 60 days before the date the change health plan will come into force
6. Notice of special rights registration
Notice describing the special registration requirements of the health plan of the group, including the right to register special within 30 days of the loss of another coverage or marriage, birth of a child, adoption or placement for adoption.
7. Form Form 5500 series (Annual Report) and Summary Annual Report (SAR)
Employers with 100 employees must file form 5500 and provide the summary annual report (SAR) summarizing each plan's annual report form 5500.
8. form 720 and patient centered Outcomes Research Institute (PCORI) Fee
employers who offer a self-insured health plan (including a repayment plan for health care) are required to file form 720 and pay the PCORI fee each year.
9. Employer CHIPRA Reviews
The CHIPRA notice informs employees of potential opportunities for premium assistance their condition, such as Medicaid, CHIP, and the premium tax credits.
10. Claims and Internal notice of appeal and external review
For internal applications, plans must provide notice of determination of unfavorable benefit and a notice of internal unfavorable final determination of benefits. After an external review, the independent review organization (IRO) issues a notice of the decision of the final exam.
11. COBRA Reviews
Notice to participants and beneficiaries the right to continue group health coverage the plan after an event qualifications, including information about other coverage options (such as markets).
FAQ - Who should provide these health plan review
According to the opinion, and the type of health benefits offered, it is either the employer, sponsor, and / or the insurer is required to prepare and distribute the map view. For more information on who must provide each of these opinions download this free PDF table
FAQ -.? When the Notice Due Health Plan
different opinions of health plan are due at different times during the plan year, and / or after specific triggering events. For a complete list of deadlines, download this free PDF table
FAQ -. Where can I find models or examples Opinion
There are many reviews of samples and online models, often provided by the governing body (eg Ministry of Labour and IRS). For links to the opinion of the sample and models see this table free PDF.
Conclusion
We hope this list of required health plan review helps you administer your health benefits in 2015, and maintain compliance with existing and new regulations.
What questions do you have on the administration of health benefits or new notice requirements? Leave a question and we will help you answer.
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