Enrollment triggers a set of plan notices that employers or plan administrators must deliver.
A new participant should receive the summary plan description, the summary of benefits and coverage, the special enrollment notice, the COBRA general notice and several others, each with its own source and timing.
The basics for employers.
A plain-English summary. This is general information, not legal advice, and the rules change, so check the current text.
Summary of Benefits and Coverage
Group health plans must provide the summary of benefits and coverage at enrollment and renewal, and on request (45 CFR 147.200).
COBRA General Notice
The general notice is due within 90 days after coverage begins (29 U.S.C. 1166 and 29 CFR 2590.606-1).
Special Enrollment Notice
Plans that are subject to HIPAA must tell eligible employees of their special enrollment rights at or before the time of initial eligibility.
How it plays out.
The summary plan description is due within 90 days after a person becomes a participant, and the plan administrator is responsible for it (29 U.S.C. 1024(b)(1)). It is easy to rely on a carrier certificate, which does not meet the requirement on its own.
Women’s Health and Cancer Rights Act notices go out at enrollment and every year after. The newborns and mothers protection statement belongs in the summary plan description.
Delivery matters as much as content. Keep proof of when each notice was sent and how, because a notice that cannot be shown to have been sent is treated as not sent.
Where this shows up in your plan.
The easiest way to meet the timing is to deliver the notices in the enrollment packet. A single packet with a signed acknowledgment covers most of them in one step.
Annual notices such as the CHIP premium assistance notice and the Medicare Part D creditable coverage notice should be added to the same calendar.
When the plan changes at renewal, a summary of material modifications or a new summary of benefits and coverage may be due, so the notice calendar should be reviewed at every renewal.
Setting it up.
Build an Enrollment Packet. Include the plan documents and required notices in one package.
Collect Acknowledgments. Keep a signed receipt with the enrollment record.
Assign Ownership. Decide who sends each notice, the employer, the carrier or an administrator.
Calendar the Annuals. Add the yearly notices to the compliance calendar.
Mistakes to avoid.
Relying on the Certificate. A carrier certificate is not a summary plan description.
No Proof of Delivery. A notice that cannot be shown is hard to defend.
Skipping the COBRA General Notice. It is due within 90 days of coverage starting.
Laws and Rules Referenced
Summary of benefits and coverage, 45 CFR 147.200 — Content and timing of the summary.
COBRA notices, 29 U.S.C. 1166 — General and election notices.
Summary plan description, 29 U.S.C. 1024(b) — When the summary plan description is due.
Women’s Health and Cancer Rights Act, 29 U.S.C. 1185b — Enrollment and annual notices.
Quick answers.
Short answers to what employers ask most. This is general information, not legal or tax advice.
When is the COBRA general notice due?
Within 90 days after coverage begins.
When is the summary plan description due?
Within 90 days after a person becomes a participant.
Is a carrier certificate enough?
Not by itself. It does not replace the summary plan description.
Who sends the notices?
Whoever the plan documents and service agreements assign, so decide in writing.
More employment law guides for Michigan employers.
Harassment and Discrimination Rules for Michigan Employers
Employer duties and the benefit-plan questions that follow.
ADA and Religious Accommodations for Michigan Employers
Employer duties and the benefit-plan questions that follow.
Independent Contractor and Joint Employer Classification Guide
Employer duties and the benefit-plan questions that follow.
Employee Handbooks and Arbitration Agreements Michigan Guide
Employer duties and the benefit-plan questions that follow.
Reductions in Force, WARN Act and Benefits Continuation
Employer duties and the benefit-plan questions that follow.
Whistleblower and Retaliation Protections for Michigan Employers
Employer duties and the benefit-plan questions that follow.
An independent employee benefits consulting firm. We look at the entire benefits program — cost, plan performance, risk and administration.
Switch to CFH. Unhappy with your broker? Your employees won’t notice. You will. →