Health Care Reform Act Notices Update—Insurers and Timing

November 4th, 2010

Our last Short Report addressing notices that group health plans are required to provide under the Patient Protection and Affordable Care Act (PPACA) prompted the following questions from a couple of our readers:

  1. What should they do if they learn that their insurer intends to provide some or all of the required notices—do they have the option of relying on those notices?
  2. What should the timing of two particular notices—notice of the right of dependent coverage for children up to age 26 and the notice of the elimination of lifetime limits on coverage—be?

We thought it would be helpful to share our responses to these questions in this Short Report.

Insurer Issued Notices

If an employer’s insurer will be providing one or more of the required notices, an employer has the option of relying on the notices, but should first make sure that the notices accurately reflect the content required by law. The employer still needs to make sure that the notices will be distributed to the appropriate individuals. Our prior Short Report identifies those individuals to whom the notices should be distributed. Employers should contact their insurers to determine which notices, if any, the insurers will be providing and, if so, whether the notices are sufficient.While coordinating with insurers may cut down on the employer’s administrative burden, ultimately, employers remain responsible for making sure that accurate notices for their group health plan are properly distributed. Employers should be in a position to draft and distribute the notices if necessary.

Timing of Certain Notices

As explained in more detail in our prior Short Report, the dependent-up-to age 26 and lifetime benefit limit notices required by the PPACA must provide the opportunity for certain individuals to enroll in the group health plan.

Dependents
Dependents under age 26 who maxed out of coverage because of age or who never enrolled because they were too old must be given 30 days to enroll in the plan.

Lifetime Limits
Individuals who exceeded lifetime limits must be given 30 days to enroll in the plan.

Coverage for individuals who enroll pursuant to the dependent coverage and lifetime limits election must begin January 1, 2011, so it is best to give these notices at least 30 days before January 1. But how far in advance? To answer this question, employers must consult with their insurers. Insurers may want the 30 day period to begin running at a particular time, for example, at the beginning of open enrollment. Employer notices need to set forth the insurer’s time frame. Employers should coordinate the timing of the election period with insurers as soon as possible to avoid inconsistent notices and possible missed opportunities for enrollment.

Filed Under: Business Law

Note: The SR Short Report is published by Stafford Rosenbaum. The SR Short Report is provided for informational purpose only and should not be construed as legal advice or an opinion on specific situations. The legal issues raised by a particular situation may differ from those addressed in the publication. We encourage you to contact one of the Stafford Rosenbaum attorneys before making a legal decision.