Summary Plan Description (SPD

§  Within 120 days of plan becoming subject to ERISA

§  Within 90 days of becoming a participant or beneficiary

§  Updated SPDs must be distributed every five years if changed or every 10 years if no  changes

Summary of Material Modifications (SMM)

No later than 210 days after the end of the Plan year in which the change is adopted

Summary Annual Report (SAR)

Within 9 months after the end of the Plan year or 2 months after filing the Form 5500.

Plan Documents under which the plan is operated

§  Copies must be furnished no later than 30 days following written request

§  Made available at principal office and certain other locations.

Summary of material reduction in covered services or benefits

Generally within 60 days of adoption of material reduction in group health plan services or benefits.

Notices

CHIPRA

State specific notices must be provided to employees where applicable.  The initial notice must be provided beginning with the first plan year after the model notices are developed. The model notices are to be developed no later than 2/9/2010.

Initial COBRA notice

Within 90 days of the later of the date plan coverage begins or the first date the plan becomes subject  to COBRA

COBRA election notice

§  Employer must notify plan administrator within 30 days of employee’s death, retirement, termination, reduction in hours or date of loss of coverage

§  Plan administrator must notify employee within 14 days after being notified of the qualifying event

Note: if employer and plan administrator are the same, the notice requirement is 44 days.

COBRA premium insufficiency

Upon insufficient premium.

Notice of Unavailability of COBRA

If applicable, within 14 days after the plan administrator receives a notice of a qualifying event.

COBRA early termination

Upon any termination of COBRA coverage that will occur before the maximum period of COBRA coverage.

HIPAA Privacy Notice

§  at the time of enrollment for new enrollees

§  upon request

§  within 60 days of a material change to the Notice

§  no less frequently than once every 3 years.  

HIPAA certificate of creditable coverage

§  Upon losing group health coverage

§  Upon becoming eligible for COBRA

§  When COBRA coverage ceases

§  Upon request anytime before losing coverage and within 24 months of losing coverage

HIPAA notice of pre-existing condition exclusion

§  Before any preexisting condition may be applied to any individual.

§  Notice may be included in a group health plan’s enrollment material

HIPAA individualized notice of pre-existing condition exclusion

Within a reasonable time after participant or covered dependent provides evidence of prior creditable coverage.

HIPAA notice of special enrollment rights

On or before the time an employee is offered an opportunity to enroll in the group health plan. Effective 4/1/2009, CHIPRA added an additional special enrollment opportunity.

NHMPA (newborn)

§  Include in SPD/SMM; SPD/SMM timeframes applicable.

Women’s Health and Cancer Rights Act notices (WHCRA)

§  Upon enrollment

§  Annually

Medical Child Support Order (MCSO)

§  Upon receipt of MCSO, administrator must issue notice including procedures for determining qualified status.

§  Notice regarding qualified status

National Medical Support Notice (NMS)

§  Employer must send Part A to the State agency or Part B to the plan administrator within 20 days after the date of the notice or sooner if reasonable.

§  Administrator must notify affected persons of receipt of the notice and procedures for determining qualified status.

§  Within 40 business days after its date or sooner, administrator must return Part B to the state agency and provide information ot affected persons.

Medicare Part D Creditable Coverage Notice

§  During the initial open enrollment period (11/15/2005- 5/15/2006)

§  Within 12 months of the annual election period (11/15-12/31) for 2007 and subsequent years

§  Before an individual is first eligible for Medicare Part D

§  Before the effective date of coverage for any Medicare eligible individual that joins the plan

§  Whenever prescription drug coverage ends or changes so that it is no longer creditable or becomes creditable

§  Upon request