518-373-4111
Employers with calendar-year plans should start preparing for open enrollment for the plan year starting Jan. 1, 2025. This process should include reviewing your company’s benefit offerings, working with vendors to make any benefit adjustments, updating benefit limits and contribution amounts for 2025, and preparing employee communications.
In addition, employers should consider providing the following benefit notices in connection with open enrollment:
Summary of Benefits and Coverage (SBC)
Group health plans and health insurance issuers must provide an SBC to applicants and enrollees each year at open enrollment or renewal time.
Children’s Health Insurance Plan (CHIP) Annual Notice
If an employer’s group health plan covers residents in a state that provides a premium subsidy under a Medicaid plan or CHIP, it must send an annual notice about the available assistance to all employees residing in that state.
Summary Plan Description (SPD)
An SPD must be provided to new plan participants within 90 days after their health plan coverage begins.
COBRA General Notice
Group health plans must provide a written General Notice of COBRA Rights to covered employees within 90 days after their health plan coverage begins.
HIPAA Privacy Notice (self-insured health plans only)
The HIPAA Privacy Rule requires self-insured health plans to maintain and provide their own privacy notices. Self-insured health plans must send privacy notices to new enrollees at certain times, including at the time of enrollment.
Special Enrollment Rights Notice
A group health plan must notify each eligible employee of their special enrollment rights under HIPAA at or before enrollment. This notice is often included in the plan’s SPD or benefits booklet provided by the issuer or third-party administrator (TPA).
Notice of Patient Protections
If a health plan requires participants to designate a participating primary care provider, the plan or issuer must provide a notice of patient protections whenever the SPD or similar description of benefits is provided to a participant. This notice is often included in the SPD or benefits booklet the issuer or TPA provides.
Women’s Health and Cancer Rights Act (WHCRA) Notice
Group health plans must provide a notice about the WHCRA’s coverage requirements at the time of enrollment and annually after enrollment. This notice is often included in the SPD or benefits booklet the issuer or TPA provides.
Upcoming Compliance Dates
Provide SAR to Plan Participants (Calendar-year Plans Only)
Employers must provide a summary annual report (SAR) to plan participants by Sept. 30, 2024, for calendar-year plans if the employee benefit plan’s Form 5500 deadline was not extended. The SAR must be provided within nine months of the close of the plan year unless the plan’s Form 5500 deadline was extended. Plans exempt from the annual 5500 filing requirement are not required to provide an SAR. Unfunded welfare plans are also generally exempt from the SAR requirement.
Watch for MLR Rebates (Fully Insured Health Plans Only)
Employers with insured health plans might receive rebates if their issuers did not meet their medical loss ratio (MLR) percentage for 2023. Rebates must be provided by Sept. 30 following the end of the MLR reporting year. Employers who receive rebates should consider their legal options for using the rebate. Any rebate amount that qualifies as a plan asset under ERISA must be used to benefit the plan’s participants and beneficiaries.
© 2024 Zywave, Inc. All rights reserved.
Streamline and Simplify Your Open Enrollment
GTM’s employee benefits design skills, cutting-edge technology, and expert HR support can help you streamline and automate processes, reduce your costs, and relieve administrative burdens, all while delivering benefits that will delight your workforce. Let the GTM Insurance Agency help you create and implement a competitive, customized, and cost-effective benefits package for your employees while reducing the burdens and costs of managing benefits on your own. GTM has access to top local insurance carriers like Anthem, Aetna, Blue Cross, CDPHP, Highmark, MVP, and others. Skip any admin fees as we shop for the best rates and plans on your behalf. Call (518) 373-4111 or get a complimentary quote today!
Enrolling in company benefits and health care programs should be a positive experience, but too often, it feels like a significant burden for both employees and benefits administrators. The Benefits Enrollment & Administration module from isolved, GTM’s HCM platform, enables employees to research, select, and enroll in the benefits that suit them — without relying on your HR team. Enhance your employee experience, simplify enrollment, and relieve headaches by consolidating HR and benefit administration to gain efficiency and marketplace competitiveness. Request a free quote to learn more.
