Health & Welfare Plans: First Quarter Reminders

The helter-skelter of the holiday season is over & Spring is just around the corner! In the world of health & welfare benefits, let’s remember the first quarter often brings new regulations & updated forms.*

•  CHIPRA Notice: The Children’s Health Insurance Program Reauthorization Act requires group health plans and group health insurance to offer special enrollment opportunities to employees or dependents who lose Medicaid or CHIP coverage.
  • Who: The U.S. Dept. of Labor (DOL) issues a model notice for employer use.
  • When: Notice must be sent annually.
  • Update: None; CHIPRA notices don’t expire until 2023 

• COBRA Notice: The Consolidated Omnibus Budget Reconciliation Act of 1985  provides certain former employees, retirees, spouses, former spouses, and dependent children the right to temporary continuation of health coverage at group rates.
  • Who: The DOL issues a model notice for use.
  • When: The Plan Administrator must mail an offer of COBRA continuation coverage to each participant and/or dependent that has a qualifying event within 14 days after the Plan Administrator is notified of a qualifying event relating to a beneficiary.  The employer must notify the Plan Administrator of the qualifying event within 30 days of the loss of coverage associated with the event.
  • Update: Click here: 2020 COBRA Model Notice 

• Disclosure to CMS Form : Employers that provide prescription drug coverage to Medicare Part D eligible individuals must disclose to the Centers for Medicare & Medicaid Services (CMS) whether the coverage is “creditable prescription drug coverage.”
  • Who: CMS
  • When: The Disclosure to CMS Form must be provided at the following times:
  • Within 60 days after the beginning of the plan year for which the disclosure is provided;
  • Within 30 days after the termination of the prescription drug coverage provided by the Plan; and
  • Within 30 days after any change in the creditable coverage status of the prescription drug coverage provided by the Plan.

• ERISA Health & Welfare & 401(k) Penalties: 2020 penalty amounts have been published by the DOL. Click on this previous blog post to review adjusted mounts: 2020 ERISA Penalty Amounts

• HIPAA Noncompliance Penalties: the Department of Health and Human Services (HHS) released final regulations for civil penalties for violations of HIPAA’s Privacy & Security Rules.
  • Click on this previous blog post to review the amounts: 2020 HIPAA Penalty Amounts.

• Protection of Substance Use Disorder (SUD) Records: Pursuant to 42 CFR Part 2, plan sponsors receiving Substance Use Disorder (SUD) records as part of the administration of the group health plan (GHP) must ensure any GHP service provider agreements, including business associate agreements, contain a statement indicating SUD records will be protected.
  • Who: Plan Sponsors who may receive SUD records in the course of administering a GHP.
  • When: A statement must be included in GHP service provider agreements by February 2, 2020. Consider review of all GHP service provider agreements, including any business associate agreements, to include a statement that SUD records will be protected. Consult counsel for specific guidance on the applicability of the regulation to a particular GHP.

*The information in this blog post is intended for general educational purposes only.  It is not intended and should not be construed as legal advice.  If legal advice or other professional assistance is or may be required with regard to any issues referenced in this post, the services of a competent legal or tax professional should be immediately sought.