The employer CHIP notice: telling employees about state premium assistance.
Some states help low-income families pay for employer coverage through Medicaid or CHIP premium assistance. Employers that offer a group health plan in those states must send employees a notice about the possible help.
The requirement.
Who Must Send It
DOL says employers that maintain a group health plan in a state with a Medicaid or CHIP program that provides premium assistance for group coverage must provide the notice, called the Employer CHIP Notice, to all employees. Employers with staff in more than one state should check each state’s status, since the list can change from year to year.
It Goes To All Employees
The notice informs employees of possible opportunities in the state where they reside, not only those enrolled in the plan. Employers often include it with annual enrollment materials or the other required notices, and keep a record of when and how each employee received it, including remote workers and those on leave.
It Connects To Special Enrollment
An employee or dependent who becomes eligible for premium assistance has a special enrollment right under the plan. HR teams should know where to route an employee’s question about premium assistance and how to reach the plan administrator quickly, because the clock for requesting enrollment can be short.
The 60-Day Window
For that event, the request for special enrollment is due within 60 days after the person is determined eligible for assistance. Calendar the deadline when an employee notifies you, document the date the request is received, and confirm the plan’s enrollment steps with the carrier so the person is not left waiting.
What the law says about CHIP and Medicaid.
Loss Of Coverage
An employee or dependent who loses Medicaid or CHIP coverage because they are no longer eligible can enroll in the employer plan if they ask within 60 days of the termination. Employers should make sure managers and HR staff know to look for this situation when an employee reports a change in a child’s or family member’s public coverage, and to act on it quickly.
New Premium Assistance
An employee or dependent who becomes eligible for premium assistance under Medicaid or CHIP can enroll if they ask within 60 days of the eligibility determination. HR teams should have a simple internal process for routing these requests to the right person, confirming the dates, and telling the carrier, so coverage is not delayed by paperwork.
Written Notice From Employers
Employers in states that offer premium assistance must give employees written notice of the available opportunities. Check each year which states your employees live in and whether the notice must go out, and keep a copy of what was sent. A benefits adviser or counsel can help you confirm the current list.
Model Notices
The Departments develop the model notices, and employers can send the notice with eligibility materials, open enrollment materials, or the summary plan description. Check that you are using the current version of the model language, adapt it only as allowed, and keep a dated copy of what was sent so you can show how the notice was delivered.
Information For The State
When a state asks, the plan administrator must disclose enough information about plan benefits for the state to assess whether premium assistance is cost effective. The administrator should know who responds to such a request, what plan information can be shared, and how to involve counsel or the carrier, so a state request is handled on time and accurately.
Other Special Enrollment Rights
Losing other coverage and gaining a dependent through marriage, birth or adoption carry 30 day windows, which are separate from the 60 day rules above. Each type of event has its own rules and deadlines, so employers should list them in one enrollment procedure, train staff to recognize them, and ask the carrier to confirm how requests are submitted.
How to handle it.
Check Each State Where Employees Live
The notice depends on where the employee resides, so a multi-state workforce may need more than one version. Build the list from payroll or HR records and update it whenever someone moves or begins working remotely, so the notice reaches every employee who may be affected by that state’s program.
Use The Model Language
DOL publishes a model notice. Ask us where to find the current version. Compare the language you send with the current published version at least once a year, and keep a dated copy of the version used, so it is easy to show what employees were given.
Send It On A Schedule
Choose a regular time, such as with open enrollment, and keep records of delivery. Tie the mailing to a recurring event, put it on the HR calendar, and keep a simple log of when and how it went out. New hires should receive it as part of onboarding as well.
Train The Enrollment Team
Make sure the people handling enrollment know a Medicaid or CHIP eligibility determination triggers a special enrollment right. A short checklist for the enrollment team, covering who to call, which dates to record and what to tell the employee, helps make sure these requests are handled quickly and consistently.
Three questions to settle.
Which States Have Employees
List the states of residence, including remote employees. Pull the list from payroll or HR records, update it when people move, and use it to determine which states’ notices apply. Ask your benefits adviser if you are unsure about a particular state.
Who Owns The Notice
Assign it to one person. Name a backup as well, write the task into the annual compliance calendar, and record where the sent notices are kept, so the process continues if the responsible person is out or leaves. A short written procedure helps new staff pick it up quickly.
Do Our Special Enrollment Materials Cover This
The 60-day Medicaid and CHIP window should appear in your enrollment procedures. Review the enrollment procedures, the handbook and the employee communications for the Medicaid and CHIP request window, and add it where it is missing. Counsel or your benefits adviser can confirm the wording.
Common Questions About The CHIP Notice
Who must send the notice?
Employers that maintain a group health plan in a state whose Medicaid or CHIP program offers premium assistance for group plan coverage.
Who gets it?
All employees, according to DOL, so they know about opportunities in the state where they live.
What if an employee becomes eligible for assistance mid-year?
The plan must allow special enrollment, with a request due within 60 days after the determination.
Where do I get the notice text?
DOL publishes a model notice. We can point you to the current version.
Do remote employees count?
The notice relates to the state where the employee resides, so include them.
Is this legal advice?
No. For your own situation, involve your counsel. We can help you set up the process.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents — two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
Laws and rules referenced
29 U.S.C. § 1181(f) and 29 C.F.R. § 2590.701-6 — HIPAA special enrollment periods: at least 30 days to request enrollment after loss of other coverage, marriage, birth or adoption.
This page is general information, not legal or tax advice. Rules change and facts matter, so confirm your situation with counsel or a qualified advisor.
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