Benefits Notices: Employers With 1-19 Employees

For companies with 1-19 employees, this chart provides an overview of key required benefits notices and filings for employers and plan administrators under federal law. Please note that your company may be exempt from certain requirements and/or subject to additional obligations under your state’s laws. Employers are encouraged to contact theU.S. Department of Labor or a knowledgeable employment law attorney for further guidance.

Employee Retirement Income Security Act (ERISA) Notices

Notice Provide To When Due
Summary Plan Description (SPD) Group health plan participants Within 90 days after the employee becomes a participant in the plan

An updated SPD must be furnished every 5 years if changes are made to SPD information or the plan is amended (otherwise, it must be furnished every 10 years)

Summary of Material Modifications (SMM)

and

Summary of Material Reduction in Covered Services or Benefits

Group health plan participants No later than 210 days after the end of the plan year in which the change is adopted, for material changes to the plan that do not result in a material reduction in covered services or benefits 

Within 60 days of adoption of a material reduction in covered services or benefits (alternatively, notice may be provided with plan information that is furnished at regular intervals of not more than 90 days, if certain conditions are met)

Note: Timely distribution of a “Notice of Modification” (below) may satisfy these requirements.

Plan Documents (e.g., SPD, any SMMs, and other documents under which the plan is established or operated) Group health plan participants & beneficiaries Copies must be furnished within 30 days of a written request, and the plan administrator must make copies available for examination at its principal office (the DOL can also request any documents relating to the plan)

Health Care Reform Notices

Notice Provide To When Due

2015 Forms 1094-B(Transmittal) and 1095-B(Health Coverage)

Individuals covered by a self-insured health plan

Form 1095-B must be furnished to covered individuals byMarch 31, 2016

Forms 1094-B and 1095-B must be filed with the IRS by May 31, 2016 (or June 30, 2016, if filing electronically)

Health Insurance Exchange Notice All new employees Within 14 days of an employee’s start date
Summary of Benefits and Coverage (SBC) & Uniform Glossary Group health plan participants & beneficiaries At specified times during the enrollment process and upon request
Notice of Modification Group health plan participants & beneficiaries No later than 60 days prior to the effective date of a material plan or coverage change that would affect the content of the SBC and that occurs other than in connection with a renewal or reissuance of coverage

Note: A complete & timely notice may also satisfy the requirement to provide an SMM.

Disclosure of Grandfather Status Group health plan participants & beneficiaries In any plan materials for a grandfathered group health plan provided to a participant or beneficiary describing the benefits provided under the plan
Notice of Patient Protections Group health plan participants Whenever a participant in a non-grandfathered group health plan that requires or provides for the designation of a participating primary care provider is furnished an SPD or other similar description of benefits under the plan
Patient-Centered Outcomes Research Institute (PCORI) Fees Filed with the Internal Revenue Service IRS Form 720 must be filed annually by plan sponsors of certainself-insured health plans, no later than July 31st of the calendar year immediately following the last day of the plan year to which a fee applies

Health Insurance Portability and Accountability Act (HIPAA) Notices

Notice Provide To When Due
Notice of Special Enrollment Rights Employees eligible to enroll in the employer’s group health plan At or before the time an employee is initially offered the opportunity to enroll in the plan
Wellness Program Disclosure Group health plan participants & beneficiaries eligible to participate in a health-contingent wellness program In all plan materials that describe the terms of the health-contingent wellness program (if the plan materials merely mention that a program is available, without describing its terms, disclosure is not required) and in any disclosure that an individual did not satisfy an initial outcome-based standard
Notice of Privacy Practices
Note: Fully insured group health plans that do not create or receive protected health information (PHI)—other than summary health and enrollment information—are not required to develop this notice.
Individuals enrolled in the plan Fully insured group plans meeting the definition of a “covered entity” that create or receive PHI in addition to summary health & enrollment information must provide the notice upon request
 

Other health plans that are covered entities must provide the notice to new enrollees at the time of enrollment and to covered individuals within 60 days of a material revision to the policy (with special rules for website notice postings); must notify covered individuals of the availability of the notice and how to obtain the notice at least once every 3 years; and must provide it upon request

Special Health Care Notices

Notice Provide To When Due
Women’s Health & Cancer Rights Act (WHCRA) Notices Group health plan participants & beneficiaries Upon enrollment in a plan that provides coverage for medical and surgical benefits related to a mastectomy, and annually thereafter
Mental Health Parity & Addiction Equity Act (MHPAEA) Disclosure Any current or potential group health plan participant, beneficiary,
or contract provider
Upon request for a plan offering medical/surgical benefits and mental health or substance use disorder benefits 

Note: Certain plans that are exempt from the requirements under the MHPAEA based on increased cost may be subject to alternative disclosure rules.

Employer Children’s Health Insurance Program (CHIP) Notice All employees Annually before the start of each plan year (may be provided concurrently with the SPD or other materials notifying the employee of plan eligibility, or in connection with an open season or election process conducted under the plan, as long as certain requirements with respect to appearance are satisfied)
Michelle’s Law Notice Group health plan participants With any notice regarding a requirement for certification of student status under a plan that bases eligibility for coverage on student status (and that provides dependent coverage beyond age 26)
Newborns’ and Mothers’ Health Protection Act Notice Group health plan participants Must be included in the SPD for a plan providing maternity or newborn infant coverage
Medicare Part D Creditable Coverage Disclosure Noticeor Non-Creditable Coverage Disclosure Notice Medicare-eligible individuals (including certain dependents) who are offered prescription drug coverage under the employer’s group health plan Annually prior to October 15th, upon request, and at variousother times as required under the law
 

An online disclosure to the Centers for Medicare & Medicaid Services (CMS) is also required annually, no later than 60 days from the beginning of a plan year, and at certain other times

Genetic Information Nondiscrimination Act (GINA) Disclosures Entities from whom requests for health-related information are made—only applicable to requests by employers with 15 or more employees Whenever an applicant or employee is sent for a medical examination

An additional “warning” is required when requests for health-related information are made (e.g., to support an employee’s request for reasonable accommodation or a request for sick leave), but only if the request for medical documentation is made in a way that is likely to result in receipt of genetic information