ACA & ERISA Employee Compliance Notices

Employers are required to provide employees with a variety of notices advising them of their rights and responsibilities. The Affordable Care Act (ACA) added to the already overwhelming amount of mandatory notices required for employers to remain compliant. Collecting and completing these notices are time-consuming – let us reduce the impact of this burden on your work load. Brochure (PDF)

Full-Service

Our Full-Service ACA Notice Service takes the work of completing the required notices out of your hands. Simply fill out our short intake form and we do the rest for you. Within days you’ll receive the completed required notices in your inbox. The complete list of the notices included is detailed below.

$340 (each company) 

 

 

All Employers - Health Care Exchange / Marketplace Notice

All Employers are responsible for providing written notices regarding Health Insurance Exchanges (also known as marketplaces) to their employees.

Employers must provide one (of two) notices. The type of notice depends on if the employer offers health benefits to some / all employees or if the employer does not offer health benefits to employees.

Compliance Date: On or before October 1, 2013 for all current Employees, New Hires – On or after October 1, 2013.  No later than 14 days from employee’s start date.

Healthcare Exchange Notice

Employers Offering Group Health Benefits


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Employers who do not offer Group Health Benefits

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All Employers That Provide Benefits Select one of the following: 

Individual Bill of Rights

Individual Bill of Rights - Simple


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Individual Bill of Rights - Detailed
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Employer Required Model Notices:

If you are not sure if your Group Health benefit plan is (or has maintained) Grandfathered Status please review the Grandfathered Status Explanation Guide.   Most group health plans are non-grandfathered plans.  If your health plan has renewed with changes or you have changed carriers, most likely, your group health plan is a non-grandfathered plan.     

Non-Grandfathered Plan Forms

Patient Protection

When applicable, it is important that individuals enrolled in a plan or health insurance coverage know of their rights to (1) choose a primary care provider or a pediatrician when a plan or issuer requires designation of a primary care physician; or (2) obtain obstetrical or gynecological care without prior authorization.
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Women’s Health & Cancer Act (WHCRA)

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA).
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Children’s Health Insurance Program Re-authorization Act (CHIP)

If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from your employer, your State may have a premium assistance program that can help pay for coverage.
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Dependent to age 26 notice – HIPAA Special Enrollment Rights

The interim final regulations extending dependent coverage to age 26 provide transitional relief for a child whose coverage ended, or who was denied coverage (or was not eligible for coverage) under a group health plan.
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Grandfathered Plan Forms

Patient Protection
When applicable, it is important that individuals enrolled in a plan or health insurance coverage know of their rights to (1) choose a primary care provider or a pediatrician when a plan or issuer requires designation of a primary care physician; or (2) obtain obstetrical or gynecological care without prior authorization.
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Women’s Health & Cancer Act (WHCRA)
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA).
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Children’s Health Insurance Program Reauthorization Act (CHIP)
If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from your employer, your State may have a premium assistance program that can help pay for coverage.
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Dependent to age 26 notice – HIPAA Special Enrollment Rights
The interim final regulations extending dependent coverage to age 26 provide transitional relief for a child whose coverage ended, or who was denied coverage (or was not eligible for coverage) under a group health plan.
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Other Notices

Wellness Program Disclosure (Only if you provide a Wellness Plan)

Required for group health plans offering a wellness program that requires an individual to satisfy a standard related to a health factor, the following is model language that may be used to satisfy the requirement that the availability of a reasonable alternative standard be disclosed.
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HIPAA Notice of Privacy

A covered entity (Employer Sponsored Health Plan) must make this notice available to any person who asks for it, a covered entity (Employer Sponsored Health Plan) must prominently post and make available this notice on any web site it maintains that provides information about its customer services or benefits.
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Newborn’s Act Disclosure

The following is language that group health plans subject to the Newborns’ Act may use in their SPDs to describe the Federal requirements relating to hospital lengths of stay in connection with childbirth.
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General Notice of Pre-Existing Condition

Plans and issuers are required to give written notice that the lifetime limit on the dollar value of all benefits no longer applies and that an individual, if covered, is once again eligible for benefits under the plan.
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Group Health Plan Pre-Existing Exclusion Waiver

This plan imposes a preexisting condition exclusion. This means that if you have a medical condition before coming to our plan, you might have to wait a certain period of time before the plan will provide coverage for that condition.
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“Optional” Declination of Coverage

If you are declining Group health benefit enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan....
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List of Model Notices and other requirements:

The following table provides a checklist of the specific notices and disclosures under health care reform. For each topic, a description of the notice or disclosure, effective date/timing of distribution, and who is required to comply.
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HRA & Some FLEX – Section 125 plans (Employers Need to consider and may have to comply with these requirements)

If you have a HRA most likely you (as an employer) will have to pay the PCORI Fee ($1.00 per employee) and “may” have to pay the fee if you have a flex plan and the employer contributes to the employees Flex amount.  Review the Explanation guide below to see if the PCORI Fee applies to you. 

HRA & Some FLEX – Section 125 Plans

PCORI Research Fee( Form 720) may be required PCORI Explantion Guide

HRA Plan Sponsors (Employers) and “SOME” Section 125 Flexible Spending Account Plan Sponsors must pay an annual fee (Section 4376 of the Internal Revenue Code). The fee is referred to as the “Comparative Effectiveness Research (PCORI) Fee”. The fee is used to fund governmental research.
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PCORI Fee – Reference Chart

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Form 720 – PDF File

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Please note:

  • The documents provided are intended to meet employer / employee notice requirements.
  • In all cases, we encourage Employers to consult with their Attorney, their CPA and / or other professionals to seek guidance regarding their Affordable Care Act and ERISA Compliance Requirements.
  • The following Notices may (or may not) be applicable to your organization’s health benefit Program.  These notices are considered resource materials intended for your use and are designed to meet Affordable Care Act Regulatory Compliance Requirements.  Some Notices will require the organization to include specific plan information prior to distribution to employees.