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A Breakdown of Benefit Notice Requirements by Company Size

by John Stebbins on Oct 19, 2018 3:29:29 PM

Federal laws and regulations require a number of benefit notices and filings of employers. Generally speaking, the documents fall into several major categories.

Types of Benefit Notices and Filings

  • Summary Plan Descriptions, Summary of Material Modifications and Plan Documents: These documents provide participants and beneficiaries information about their plan and any changes to it.
  • ACA Notices: Group health plans under the ACA must provide a number of informational notices to participants, beneficiaries and other individuals eligible for benefits under the plan.
  • COBRA Notices: For certain sized employers, notices of the temporary extension of health coverage when group coverage ends is required.
  • HIPAA Portability and Nondiscrimination Notices: These notices specify the rights of participants and beneficiaries related to preexisting conditions, discrimination based on health status and special enrollment opportunities.
  • Special Health Care Notices: Employers who offer certain types of coverage and those in certain states who provide premium assistance through Medicaid or CHIP have additional notice requirements.
  • Benefit Claims Notices: Written explanations are due to claimants when a health plan denies payment for a treatment or service.
  • HIPAA Privacy and Security-Related Notices: Covered entities must provide notices to individuals that explain their rights with respect to their health information.
  • Medicare Part D Creditable Coverage Notices: For those whose policies include prescription drug coverage, Medicare-eligible policyholders must be notified about whether their coverage is creditable coverage.
  • Family and Medical Leave Act (FMLA) Notices: Eligible employees of covered employers must receive specific notices explaining their FMLA rights.

The Cost of Noncompliance

As the amount of information required of employers escalates, so too does the cost of noncompliance, with penalties continuing to increase. For example, fines for failing to supply a Summary of Benefits and Coverage rose to $1,128 per failure in 2018.

And while many companies believe that the requirements only apply to those with 50 or more employees, that’s not the case. Even small businesses must keep up with reporting. In fact, organizations with just one to 19 employees must provide over 20 benefit notices and filings ever year. And keeping track of what’s required, when, can be difficult.

To help ease the burden on your HR department, we’ve compiled a list of the mandatory documents by company size. Keep in mind, however, that your state’s laws may impact these obligations. Click here to access the chart.

Required Benefits Notices Chart


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