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Special Health Care Notices

For Administrators and Employees

Companies must deliver certain notices to employees whom they offer insurance coverage. Below is a brief overview of these notices.

Women's Health & Cancer Rights Act (WHCRA) Notices

These must be provided to all group health plan participants and their beneficiaries. This is due 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

The MHPAEA Disclosure requires group health plans and health insurance issuers that provide coverage for either mental health or substance use disorder benefits and medical or surgical benefits to provide employees with information about mental health coverage upon request. The disclosure must explain the standards used for medical necessity determinations, made in connection with mental health or substance abuse disorder benefits. Requesting participants must also be notified of any denials of, or non-quantitative treatment limitations (NQTLs) on, mental health coverage benefits, including the reasons for the decision.

Certain plans that are exempt from the requirements under the MHPAEA based on increased cost may be subject to alternative disclosure rules. NOTE: Small employers, defined as 50 or fewer employees under ERISA remain exempt from MHPAEA requirements, regardless of changing state definitions.

Employer Children's Health Insurance Program (CHIP) Notice

This must be provided to all employees annually before the start of each plan year. This 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 to appearance are satisfied.

Michelle's Law Notice

Michelle's Law prohibits plans from terminating the coverage of a dependent student on a medically necessary leave of absence from their school. While the ACA requires coverage for dependents up to the age of 26 regardless of status, Michelle's Law provisions still apply to plans that extend dependent coverage past the age of 26, and where a dependent's eligibility is contingent on their student status. A medically necessary leave of absence occurs when the child is suffering from a major illness or injury and must take a leave of absence that would otherwise cause them to lose "student status" and become ineligible under the terms of the plan.

Where the plan requires a certification of student status for purposes of dependent coverage, it must also provide a notice to plan participants that describes the dependent's right to continuing coverage during a medically necessary leave of absence, for the earlier of the following:

  • Up to 12 months after the date the absence began; or
  • Until the date coverage would otherwise terminate under the plan

The dependent will qualify for continuing coverage provided they were enrolled on the basis of their student status, immediately before the first day of their medically necessary absence, and are considered a dependent child of a participant or beneficiary under the plan.

Newborns' and Mothers' Health Protection Act Notice

This must be provided to all group health plan participants and must be included in the SPD for a plan providing maternity or newborn infant coverage.

Medicare Part D Creditable Coverage Disclosure Notice or Non- Creditable Coverage Disclosure Notice

Must be provided to Medicare-eligible individuals (including certain dependents) who are offered prescription drug coverage under the employer's group health plan. This is due annually prior to October 15th, upon request, and at various other 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.

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