Initial Employee Enrollment:

Once the employee has indicated they would like to enroll into benefits, the benefits administrator from your company notifies the insurance carrier (typically through an enrollment form or online process).  In addition to notifying the carrier, there are several documents that are also required tat this time.

Summary Plan Description (SPD)Pre-Existing ExclusionsNotice of Privacy PracticesCobra-InitialMedicare Part D Credible CoverageWoman & Cancer RightsPremium Only Plan (POP) Automatic EnrollmentSummary of Benefits & Coverege (SBC)Qualifying Events

The SPD is the document that informs participants and beneficiaries about their benefits, rights, and obligations under the health plan and how the plan operates.  It must be comprehensive and written in simple terms.  Distribution should occur within 90 days of becoming covered under the plan and updated SPD’s must be provided if changes are made.  Otherwise, a new SPD must be furnished every 10 years and copies provided with 30 days of request.

Discontinued as of January 1st, 2015. 

Notice of Privacy Practices describes individual rights under HIPAA Privacy regulations.  Self-funded plans must distribute this notice at the time of enrollment and within 60 days of revision.  Fully insured plans that maintain Private Health Information (PHI_ must maintain provide notice upon request.  If you do not maintain any PHI you do not have to issue this notice.

This notice describes and individual’s rights under COBRA continuation.  It may be distributed as a stand-alone notice or included in the Plan Summary.  The notice should be distributed to the covered employee and covered spouse (if applicable) within 90 days of the effective date of coverage.  If spouse is enrolled after the first 90 days of coverage of the employee (i.e. mid-plan year), a separate notice would need to be distributed to the spouse.

 

This notice informs Medicare Part D eligible participants whether the prescription drug coverage under the group’s plan is credible (equal or greater than coverage provided under Part D).  This allows these individuals to make an informed decision regarding enrollment into Part D, as those with non-credible coverage may be penalized for last enrollment into Medicare Part D.

This notice describes required mastectomy-related benefits requied to be provided under WHCRA.  For group plans that include mastectomy benefits, this notice should be distributed to employees at enrollment into the plan and annual thereafter.  Notice can be on enrollment documents instead of a stand-alone form

This form is a sample that you can use to notify employees about the automatic enrollment feature of the plan.  We are including this form in Word format so that you can modify accordingly.  This should be distributed annually and to each employee at open enrollment and also to new employees upon initial enrollment into the plan throughout the year.

The SBC is typically provided in one of 3 ways depending on the insurance carrier.  1.  Directly from the insurer  2.  From your agent  3.  Available to you through an online link provided by insurer.  It’s important to note that the insurer’s do not always provide the Uniform Glossary, however they are required to accompany the SBC.

Not sure if an employee’s reason to enroll outside of the initial or open enrollment is acceptable? Here’s a list of all the qualifying events for employees to enroll anytime of the year.

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