Specific Participant Notices and Disclosures Under Health Care Reform

The following provides a checklist of the specific notices and disclosures under health care reform. For each topic, we provide a citation to the statutory provision, a description of the notice or disclosure, effective date/timing of distribution, and who is required to comply.

Exchange Notice [FLSA§ 18B]

Information on Exchanges and the consequences if employee purchases a QHP through Exchange in lieu of employersponsored coverage

To new employees hired after October 1, 2013, within 14 days of their start date

Employers subject to FLSA

Patient protections [PHSA § 2719A]

Choice of primary care provider/ pediatrician (if plan requires or allows for this) and OB/GYN care without referral (if applicable, include in SPD or any description of benefits)

(Notice of the right to designate any participating PCP; designate a pediatrician as PCP for any child and obtain OB/GYN care without PA or referral)

Rescissions Prohibition

[PHSA § 2712]

Information Reporting of Minimum Essential Coverage MEC (Insurers and Employers That Self- Insure)

[Code § 6055]

Information Reporting of Employer-Sponsored Coverage (Applicable Large Employers ALE)

[Code § 6056]

Summary of Benefits and Coverage (SBC) & Glossary of Terms & Notice of Material Modifications to SBC {SMM}

[PHSA § 2715]

30 day advance notice of retroactive cancellation or discontinuance of coverage (permitted only in limited circumstances such as fraud or misrepresentation of a material fact upon event or on request)

Forms 1094-B directly to IRS and 1095-B to covered employee

Written statement of health coverage provided

Forms 1094-C directly to IRS and 1095-C to the covered employee

Written statement of health coverage provided

SBC must meet certain appearance, language, and content requirements & 60-day advance notice required for material modifications not reflected in most recent summary

9/23/10

After 9/23/10

Generally, annually on or before 1/31 after calendar year in which coverage was provided

Group health plans and insurers (n/a to grandfathered plans or coverage)

Generally, annually on or before 1/31 after calendar year in which coverage was provided

Distribution starting with first open enrollment beginning on or after 9/23/12; Exchange/FFM notice must occur within 14 days after start date

Group health plans and insurers

For Insurers, sponsors of self-insured plans, and other entities providing “minimum essential coverage”

Applicable large employers

Group health plans and insurers