Health Care Reform: Notice the Notices
If you are a regular reader, you know that I have been spending a lot of time addressing health care reform and upcoming plan administration and design issues. As part of that administration process, it is important that plan sponsors not overlook some of the notice requirements that are hidden within the rules. It is important to prepare for the required communications and, fortunately, the DOL has give us some samples. So what is coming up?
1. Notice of Key Plan Design Changes
For most plans, the target date for compliance will be January 1, 2011. So these notices are probably a good place to focus first. The DOL has given us a notice for Annual and Lifetime Limit Changes (http://www.dol.gov/ebsa/lifetimelimitsmodelnotice.doc), a notice for Older Children Dependent Eligibility (http://www.dol.gov/ebsa/dependentsmodelnotice.doc), and a model for Primary Care Physician Designation (http://www.dol.gov/ebsa/patientprotectionmodelnotice.doc ). Of course you will have to modify these notices to fit your plan, but they give us an idea of what will have to be in place.
2. Summary of Material Changes
Some time in 2012, plans or sponsors will have to send participants a written summary of any plan changes at least 60 days prior to the beginning of their plan year. This is not the SPD or a summary of material modifications but rather will be targeted to summarize what changes are being made to comply with health care reform.
These notices will be required by March 23, 2012, and ideally we will have DOL models before then.
3. Summary of Medical Coverage
This plan summary is also due in the 2012 plan year and it will be referred to as a “uniform explanation of coverage.” Limited to 4 pages and 12-point font, The summary must include specific content and definitions, and be written in language that is “linguistically” and “culturally” appropriate. Again, this will not replace and SPD, but will likely supplement it as a uniform statement of certain required benefits.
4. Summary of Managed Care Programs
2012 looks like a big year for notices as we expect model language on notices that will describe all care management programs. These will deal with wellness and disease management programs. So to the extent an employer may not already have its wellness programs fully explained in writing, this notice will require those statements.
5. Automatic Enrollment
As we get closer to 2014 and the penalties, employers will likely be looking at automatic enrollment and preparing for employees who want to opt-out of employer coverage. In 2013, we can anticipate providing participants that they are automatically being enrolled in medical coverage and what actions they must take to opt-out.
6. Eligibility for Health Insurance Exchange
Coupled with the employee choice and the creation of the exchanges, we are going to have notices explaining what they are and how to access them. Presumably, these notices will include information about eligibility rules for premium credits and the differences between an exchange plan and an employer-sponsored plan.
So start with number 1, getting the 2011 notices and information in place. Dutifully watch to see what sample or model notices are release next and continue to prepare your plan for full compliance. And above all, don't miss any notices requirements because communication to participants will be the key to avoiding complaints.
