Your employee has been onboarded, you provided all of the disclosures for health and welfare plans as required, and now you can sit back and contemplate a job well done. Don’t contemplate too long because your disclosure tasks have just begun. Throughout the year, there are additional disclosure notices required. This article outlines those that must automatically be sent.
REQUIREMENTS & RECOMMENDATIONS
- Summary Plan Description (SPD) –You must distribute every 5 years to existing participants if made change or every 10 years if they have not. Assuming that you have made changes, the five-year distribution is a good opportunity to remind employees of the major provisions and Updates. Remember, the SPD that you distribute must reflect the provisions in effect not more that 120 days prior to the date you distributed.
- Summary of Material Modification (SMM) – Must be distributed within 210 days after the end of the plan year in which you adopted a change. It is far better to announce changes and update your SPD well before this point.
- Summary of Material Reduction in Covered Service or Benefits – if you make material reductions in health plan benefits or services, you must distribute this within 60 days of the date of the change. Ideally, this should be distributed with your annual enrollment materials or, if you are making a mid-year change, in advance of the effective date of the change.
- Summary Annual Report (SAR) – Summary of your Form 5500 or 5500-SF. Must be distributed to participants within nine months after the end of the Plan Year or two months after the due date for filing your 5500 if you have an approved extension. Strongly recommend that you send clarifying information along with the SAR explaining what it is.
- Employer CHIPRA Notice – informs employees of premium assistance available in their state. This must be distributed annually, preferably during annual enrollment.
- Women’s Health & Cancer Rights Act (WHCRA) Notice – describes benefits for post-mastectomy services. This must be distributed annually, preferably during annual enrollment.
- Summary of Benefits Coverage (SBC) & Uniform Glossary – your insurer or plan administrator will provide this to the plan, and you must distribute with enrollment materials. It must also be provided to special enrollees within 90 days of enrollment
- SBC Notice of Modification – if you make a material modification that would affect the SBC. This must be provided 60 days in advance of the change.
- Notice Regarding Designation of Primary Care Provider – if the plan requires a participant to select a PCP, this must be provided, generally with the SPD or other descriptive materials.
- Notice of Benefit Determination or EOB – your carrier or claims administrator will provide these to claimants. However, it is the Plan’s responsibility to ensure that your carrier or claims administrator is including all required language.
- Wellness Program Disclosure – if you offer a Wellness program that includes rewards, this notice outlines the availability of alternate standards. Must be distributed with all plan material.
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Employers may also want to include additional communications explaining what all of these notices are and that the employer is mandated to provide them. You also must keep records showing when and how the notices were distributed.
If you need assistance with developing any of these notices, communicating with employees or carriers about the notices, or developing checklists, Trinity HR Consulting can help.
- This includes conducting an audit of your benefit plans to identify issues & provide specific corrective actions to avoid the consequences of violations.
- Email me at KathleenSholinsky@TrinityHR.net or Trinity at info@TrinityHR.net
- Visit our website at www.TrinityHR.net
- Call us at 865.905.1762 or Toll Free at 877.228.6810
Author: Kathleen Sholinsky, Senior Consultant
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