Health care reform compliance deadlines are closing in on us. I have been asked by numerous clients and plan professional about "action items" that should be in place after September 23, 2010. So I thought I would share them here. And let's start with notice requirements to participants.
- Grandfathered Plan Status Notice. First, you have to understand grandfathering, then decide whether or not you are maintaining grandfathered status. If you are, participants are entitled to a notice of intent to maintain grandfathered status.
- Special Enrollment Notices for Lifetime Limits. For individuals who have otherwise reached lifetime limits under a plan are entitled to a special enrollment notice identifying that they are now available for coverage. With the lifetime limit going away, these folks are not coming back on the plan per se, but they will have the ability to have claims paid again.
- Patient Protection Notice for Physician Choice. This notice advises participants that they have the ability to designate primary care physicians and to obtain OB/GYN care without prior authorization.
- Notice of Age 26 Coverage Extension. With the expansion of coverage to individuals up to age 26, participants have to be notified of that option and they have to be provided enrollment rights and instructions.
- Appeal Rights. With the possible addition of external appeals that applies to non-grandfathered plans, participants have to be told about the new appeals rights. Plus they should be reminded of the existing appeal rights under the plan.
So step 1, you have to decide what notices are required based on your plan. Step 2 is to decide who gets those notices and step 3 is to draft the notices and send them out. Certainly you can rely on the insurance company for these notices provided the insurance company is sending them out. But ultimately it is the responsibility of the plan sponsor to make sure notices are being correctly sent. So don't assume. Ask questions, Contact the company, your broker and your plan professionals to make sure you are dealing with these new notice requirements.