Sample Open Enrollment Notices Packet

Including: 

• Important Notice About Your Prescription Drug Coverage and Medicare: Provide this notice by October 14 to all participants and dependents who are or may become eligible for Medicare Part D in the next 12 months if the prescription drug coverage provided by the plan is “creditable.” (Your carrier or Rx vendor can tell you if the coverage is creditable.)
• Important Notice About Your Prescription Drug Coverage and Medicare: Provide this notice by October 14 to all participants and dependents who are or may become eligible for Medicare Part D in the next 12 months if the prescription drug coverage provided by the plan is not “creditable.” (Your carrier or Rx vendor can tell you if the coverage is creditable.)
• Women’s Health and Cancer Rights Act Notice: Provide this notice at least once a year to all participants.
• Newborns’ and Mothers’ Health Protection Act: Provide this notice at least once a year to all participants.
• Premium Assistance under Medicaid and the Children’s Health Insurance Program (CHIP): Provide this notice before the start of the plan year if you have any employees in a state listed in the notice. (These states provide premium assistance for CHIP and/or Medicaid coverage.) Caution: This notice is updated regularly. Check at www.dol.gov/ebsa/chipmodelnotice.doc for the most current version if you do not promptly distribute this notice.
• Wellness Program – Notice of Reasonable Alternatives: Provide this notice only if you have a wellness program that considers health status.
• Grandfathered Plan Notice: Provide this notice only if the plan is grandfathered.
• Patient Protection Notice: Provide this notice if the plan requires designation of a primary care provider; tailor as needed.
• HIPAA Notice of Privacy Practices: Provide this notice every three years or less.
• Notice to Enrollees Regarding Opt-Out: Provide this notice only if the plan is a self-funded nonfederal governmental group health plan that has opted out of some or all of HIPAA; tailor as needed to describe what the plan has opted out of.
• Notice of Special Enrollment Rights: Give this notice to all new enrollees.
• Continuation Coverage Rights Under COBRA: Give this notice to all new enrollees – including new spouses – if you employ 20 or more people. (Please be aware that many states have “mini-COBRA” laws that may require an employer or plan sponsor to provide additional, different notice of “mini-COBRA” rights.)
• New Health Insurance Marketplace Coverage Options and Your Health Coverage: Provide this notice to all new employees (even if they are part-time/temporary/not eligible for the plan) within 14 days after their hire date if you offer coverage to any employee. Note that completing questions 13 – 16 is optional. At this time, providing information on minimum value and affordability is required.

Updated September 2021