Special Enrollment and Newborns’ Act Notices: What Plan Documents Must Say
Both rules come with a notice. Employees must hear about special enrollment rights when first offered coverage, and plans that cover maternity or newborn care must describe the childbirth stay limits in the summary plan description.
Notices and Documents.
General information, not legal advice. Read the overview and the two topic pages these notices describe.
HIPAA Special Enrollment and the Newborns’ Act
The overview of this series, with all five topics, the sources and a first-steps list.
Special Enrollment After Loss of Other Coverage
Which losses of other coverage open a special enrollment right, and which do not.
Newborns’ Act 48 and 96 Hour Hospital Stay Rules
The childbirth stay minimums, the cost-sharing limit and the no-authorization rule.
At or Before the Offer.
The regulation at 29 CFR 2590.701-6(c) requires the plan to provide a notice of special enrollment rights at or before the time an employee is initially offered the opportunity to enroll. The regulation sets out model language that describes the right to enroll after losing other coverage or after a new marriage, birth, adoption or placement, along with a contact instruction.
If the plan requires a written statement from employees who decline coverage, the notice must also describe that requirement. This is the same notice that makes the statement enforceable, as our loss of coverage page explains.
The regulation text we read does not mention the summary plan description in connection with this notice. We therefore treat the offer-time notice as its own duty. Many employers also repeat it in the SPD and in open enrollment materials, which is good practice, though not something the cited text requires.
The SPD Statement.
ERISA section 711(d), 29 U.S.C. 1185(d), treats the imposition of the hospital stay requirements as a material modification of plan terms for notice purposes, and gave plans a deadline of 60 days after the first day of the first plan year in which the requirements applied. That first-year deadline is now long past, but the underlying disclosure continues.
The ongoing rule sits in 29 CFR 2520.102-3(u). The SPD of a plan that provides maternity or newborn coverage must describe the federal or state requirements that limit hospital stays after childbirth, along with any related coverage. If federal and state rules differ by area, the SPD must identify each area and its rule.
The regulation supplies a model statement for plans subject to section 711. Using it satisfies the federal part of the requirement. It says, in substance, that federal law generally bars restricting the stay to less than 48 hours or 96 hours, that the attending provider may discharge earlier after consulting the mother, and that no authorization may be required to prescribe a stay within the minimum.
Terms to Check.
Open the plan document and the SPD side by side and look for five items: the length of the special enrollment request window, the counting rule, the effective dates, whether a written declination statement is required, and the childbirth stay statement. The first four should match the federal floors on our windows page.
Check that special enrollees are described as receiving the same benefit packages as people who enroll when first eligible, at no higher charge, because the regulation requires it.
A handbook paragraph is not a substitute. If your only description of these rights sits in an employee handbook, see our page on why a handbook is not a summary plan description.
Putting It in the Packet.
Open enrollment is the natural place to hand over the offer-time notice, since new hires and annual enrollees both receive the packet. Pair the notice with the waiver form so the written-statement language and the notice sit on the same page.
For new hires, make sure the notice goes out with the first offer of coverage and not on day 31. Keep a dated copy of the packet for each plan year.
We help clients compare their plan documents, forms and carrier contracts to these requirements before the packet goes out. If something looks missing, bring us the documents and we will mark the gaps.
Related Rules and Tools.
Why an Employee Handbook Is Not a Summary Plan Description
Why a handbook cannot stand in for the plan document and SPD.
Special Enrollment and Health Factor Nondiscrimination Checklist
A checklist that pairs special enrollment with the health factor rules.
A Compliance Calendar for Your Plan
A plan-year view of the filings, notices and deadlines an employer plan carries.
Laws and Sources
29 CFR 2590.701-6: the regulation on special enrollment periods, notice and effective dates.
ERISA section 711, 29 U.S.C. 1185: standards relating to benefits for mothers and newborns.
29 CFR 2520.102-3(u): the summary plan description content rule for the childbirth hospital stay statement.
DOL EBSA: Newborns’ and Mothers’ Health Protection Act: the Department of Labor overview page for the Act. The page loaded, but we did not capture its body text, so we rely on the statute and regulations above.
General information, not legal or tax advice.
Quick Answers.
Short replies on this page’s topic, each tied to a fuller guide.
When must employees receive notice of their special enrollment rights?
At or before the time an employee is initially offered the opportunity to enroll, according to 29 CFR 2590.701-6(c).
Does the summary plan description need a childbirth hospital stay statement?
If the plan provides maternity or newborn coverage, yes. 29 CFR 2520.102-3(u) requires the SPD to describe the federal or state limits on hospital stays after childbirth, and offers a model statement.
Is an employee handbook enough to describe these rights?
No. A handbook is not a substitute for the plan document or the summary plan description, and the offer-time notice is its own requirement.
The Rest of This Series.
Special Enrollment for Marriage, Birth, and Adoption
New spouses, newborns and adopted children, and when their coverage starts.
Special Enrollment Windows and Effective Dates
The 30-day floor, the 60-day public program rights and the coverage start dates.
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