The Employer CHIP Premium Assistance Notice: Who Sends It And When
Employers with a group health plan in a state that offers Medicaid or CHIP premium assistance must give employees a written notice about it, and DOL publishes a model. Here is how the duty works and what happens if it is missed.
What The Notice Duty Covers.
General information, not legal or tax advice.
CHIPRA Premium Assistance and CHIP Special Enrollment
The overview of the whole series, with the short version of the law.
The 60-Day CHIP Special Enrollment Window
The right the notice tells employees about.
How CHIP Premium Assistance Works With Your Group Plan
What the state pays once an employee opts in.
Who, What And How Often.
Under ERISA section 701(f)(3)(B)(i)(I), 29 U.S.C. 1181(f)(3)(B)(i)(I), each employer that maintains a group health plan in a state that provides medical assistance under a state Medicaid plan must give each employee a written notice of the potential opportunities then currently available in the state where the employee resides for premium assistance for health coverage of the employee or the employee’s dependents. DOL describes the subject as Medicaid and CHIP premium assistance.
The duty sits with the employer, not with the plan or the carrier. DOL’s chart of required notices lists it as an employer notice that must go to all employees.
DOL’s FAQs say the notice must be provided annually. The statute does not state a frequency. The annual expectation comes from DOL guidance and from the 2010 Federal Register notice that published the model, which refers to initial annual notices.
Riding With Enrollment Materials.
The statute allows an employer to provide the model notice for the employee’s state together with materials about plan eligibility, open season or election materials, or the summary plan description (paragraph (B)(i)(III)). That means the notice does not need its own mailing.
DOL’s FAQs add conditions: the materials must reach all employees, arrive on time and follow DOL’s disclosure rules. The 2010 Federal Register notice says delivery may be by first-class mail or electronically under DOL’s safe harbor, and that a multistate employer can use the national model as a template while including at least the contact information for any state with a program where an employee lives.
Building The Annual Routine.
Pull the current model notice from the EBSA website each year. DOL says the state contact information is updated periodically, and the 2010 notice says DOL intends to update the state list annually. The docket page in our sources links the model files.
List employees by state of residence, not by where the plan was sold, and confirm every state where an employee lives appears in the version you send.
Keep dated proof of delivery in the plan-year file, and put the send date on your compliance calendar so it does not depend on one person’s memory.
Penalty And Gaps.
ERISA section 502(c)(9), 29 U.S.C. 1132(c)(9), lets the Secretary of Labor assess a civil penalty of up to $100 a day against an employer that fails to meet this requirement, and each violation with respect to a single employee counts as a separate violation. The $100 figure is the statutory text. We did not verify the current inflation-adjusted amount, so confirm it before quoting a number.
We could not confirm a single calendar deadline for the annual notice. The 2010 Federal Register notice set the first deadline by reference to plan years starting after February 4, 2010, and the DOL FAQ points to a date that does not appear in the answer we read. Sending the notice with the enrollment materials each year is our working practice, not a verified rule.
Related Rules And Tools.
A Compliance Calendar for Your Plan Year
A plan-year view of the dates that matter.
ERISA Part 7 Group Health Plan Requirements Checklist
The wider federal rules for group health plans.
Selecting and Monitoring Health Plan Service Providers
How to hold a vendor to the notice task.
Laws And Sources
ERISA Section 701(f), 29 U.S.C. 1181: The statute text for the CHIP special enrollment right in paragraph (f)(3), the employer notice duty and the plan administrator disclosure to states.
ERISA Section 502(c)(9), 29 U.S.C. 1132: The civil penalty of up to $100 a day for an employer that fails the CHIP notice duty.
Federal Register, February 4, 2010, Model Notice for Employers: DOL and HHS publication of the model employer notice, with the first deadlines and delivery rules.
DOL EBSA, CHIP Model Notice for Employers: The DOL docket page for the 2010 model notice, with links to the English and Spanish model notice files.
DOL Health Coverage Portability (HIPAA) Compliance FAQs: DOL answers on the Employer CHIP Notice, the annual requirement, the model notice and the SPD.
DOL Compliance Assistance Guide, Appendix B, Chart of Required Notices: DOL’s chart listing the employer notice on premium assistance under Medicaid or CHIP.
DOL EBSA, CHIPRA: The Department of Labor page for the Children’s Health Insurance Program Reauthorization Act and its employer topics.
General information, not legal or tax advice.
Quick Answers.
Short replies on who sends the CHIP notice and how.
Can we send the CHIP notice with our open enrollment packet?
Yes. The statute allows the model notice to be provided with plan eligibility materials, open season materials or the SPD. DOL’s FAQs require that those materials reach all employees, arrive on time and follow DOL’s disclosure rules.
Do employees in other states need a different notice?
The notice must cover the state where each employee resides. The 2010 Federal Register notice says a multistate employer can use the national model as a template and must include at least the contact information for any state with a premium assistance program where an employee lives.
Who at the company is responsible for sending the notice?
The employer, not the carrier or the plan. DOL’s chart of required notices describes it as an employer notice to all employees. If a vendor runs your enrollment, ask it to confirm in writing that it sends the notice, because the legal duty stays with you.
The Rest Of This Series.
CHIPRA Premium Assistance and CHIP Special Enrollment
The overview of the whole series, with the short version of the law.
The 60-Day CHIP Special Enrollment Window
The two events and the 60-day request period.
How CHIP Premium Assistance Works With Your Group Plan
The subsidy, the voluntary election and the state request for plan information.
Plan Document and SPD Language for CHIP Special Enrollment
Language for your documents and the points we could not confirm.
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