What you are legally required to hand your employees.

Summary Plan Description

Within 90 days of a participant becoming covered. Refreshed every 5 years if the plan has been amended, every 10 if it has not.

The document an auditor asks for first, and the one most often missing.

Summary of Material Modification

Within 210 days after the plan year in which the change was adopted — but a material reduction in group health benefits drops that to 60 days from adoption.

The 60-day rule is the one that catches people: cutting a benefit starts a much faster clock than adding one.

Summary of Benefits and Coverage

With enrollment materials, on renewal, and within 7 business days of any request. A mid-year material change not already in the SBC needs 60 days notice beforehand.

Every group health plan, grandfathered included. Comes with the Uniform Glossary.

2026 — The template itself has not changed — the version for plan years beginning on or after 1 January 2021 is still current. What did change is the county data behind the language-access footer, so a carrier SBC built on the old county list can carry the wrong statement.

HIPAA special enrollment rights

At or before the moment an employee is first offered the chance to enroll.

Explains the mid-year enrollment rights that come with marriage, birth, adoption or loss of other coverage.

Medicare Part D creditable coverage

Annually before 15 October, plus at initial eligibility, at a new hire’s coverage start, on any change in creditable status, and on request.

Any employer offering prescription coverage to anyone Medicare-eligible. No size threshold at all — this one catches small employers who assume it does not apply.

2026 — CMS revised the simplified determination behind this notice. The old method asked whether the plan was expected to pay 60% of prescription drug costs; the revised one asks 72%. For 2026 a group plan that does not claim the retiree drug subsidy may use either. Re-test before the October notice goes out, because the creditable and non-creditable versions are different documents.

Marketplace / Exchange notice

To every new hire within 14 days of their start date.

Required of every FLSA-covered employer, whether or not you offer a plan, and to every employee whether or not they enroll.

2026 — Do not send DOL’s model as posted. It still carries the 2023 affordability figure of 9.12% and still describes a Medicaid and CHIP unwinding enrollment period that closed in July 2024. Replace the figure with 9.96% for plan years beginning in 2026, or 10.22% for 2027, and delete the unwinding passage.

WHCRA notice

Twice: on enrollment and annually thereafter.

Any plan covering mastectomy benefits. The annual repeat is the half that gets forgotten.

Newborns’ and Mothers’ Health Protection Act

Carried in the SPD.

Plans covering hospital stays for childbirth.

Claims, appeals and external review

At the point of any adverse benefit determination, with the process described in the plan documents.

Every plan. The denial letter itself is a regulated disclosure.

CHIP premium assistance notice

Annually, before the start of each plan year, to every employee — not only the ones enrolled.

Any employer with employees living in a state that runs a premium assistance program, whichever state the employer itself sits in. DOL publishes an official model with the full state table; paste it verbatim.

2026 — the model’s state list is current as of 31 July 2026. Replace the whole table rather than editing the one already in your booklet. States leave the list as well as join it, and an edit in place leaves the departed ones behind.

Filings

Form 5500 and the 1094 transmittals. The SAR is the participant-facing half of the 5500; the 5500 itself is not.

Attestations and data

The annual gag clause attestation, prescription drug data reporting, and the disclosure to CMS confirming whether your drug coverage is creditable.

Public postings

Machine-readable transparency files and the balance-billing disclosure that has to sit on a public website — published, but not delivered to anyone.

Can we just put all of this in the annual benefits guide?

Some of it, not all. Anything with its own trigger and its own clock has to be delivered on that trigger — a new hire on their start date, a plan change before it takes effect, a qualifying event. An annual booklet cannot satisfy a 14-day clock that starts the day somebody is hired, however complete the booklet is.

What does a new hire actually have to receive, and when?

Five things on five different clocks. The Marketplace notice within 14 days of the start date. The Summary of Benefits and Coverage with the enrollment materials, or by the first date they are eligible. HIPAA special enrollment rights at or before enrollment. The Summary Plan Description within 90 days of becoming covered. The COBRA general notice within 90 days of coverage beginning. Most employers hand over one packet at orientation and never check that all five were met.

Do employees who waive coverage still get notices?

Some of them. The Marketplace notice goes to every employee regardless of whether they enrolled and regardless of part-time or full-time status. The notices that describe the plan — the SPD, summaries of material modification, the SBC — go to participants. The dividing line is whether the notice is about your plan or about the employee’s own options.

How do we prove we delivered one?

The standard is delivery by means reasonably calculated to ensure actual receipt — not making the document available. A notice sitting on an intranet nobody was told about has not been furnished. In practice that means a dated distribution record, and for anything sent electronically, whatever you have that shows it arrived.

We do not offer a health plan. Does any of this apply?

The Marketplace notice does. It is an obligation on employers covered by the Fair Labor Standards Act rather than on plans, so it applies whether or not you sponsor coverage, and it goes to every employee. Employers who decided not to offer benefits are the group most likely to have never heard of it.

Our carrier sends some of these. Are we covered?

A vendor can send a notice. The plan administrator stays responsible for it having been sent. If a carrier, TPA or payroll system handles part of the list, get it in writing which parts, and confirm it annually rather than assuming last year’s arrangement held. Where a notice is about the plan rather than the insurance, the carrier usually cannot satisfy it in substance at all.

Do notices have to be in another language?

Sometimes, and the tests are not the same one. The Summary Plan Description uses your own participant counts — 25 percent in a plan with fewer than 100 participants, or the lesser of 500 or 10 percent in a larger plan — and what it requires is a prominent notice offering assistance, not a full translation. The SBC follows a separate standard based on the county rather than on your plan.

What starts when an employee leaves?

The COBRA clocks, and they are short: the employer tells the plan administrator, the administrator issues the election notice, and the former employee’s election window runs from there. The detail that catches people is that the reason for the separation is what decides eligibility — and that reason almost never travels automatically from payroll into the benefits system, which defaults it to a voluntary resignation.

Which one do employers miss most often?

The Medicare Part D creditable coverage notice, because it is really two obligations on two different clocks: the notice to Medicare-eligible employees before October 15, and the online disclosure to CMS within 60 days of the start of your plan year. There is no size exemption, the plan-year clock does not line up with the calendar one, and whether the coverage is still creditable is a determination that can move from one year to the next.

We think we have missed some. Where do we start?

With the ones that have a clock attached and a person waiting: anyone hired in the last 90 days, anyone who had a qualifying event, and anyone who asked in writing for a document. Then work through the annual set. An omission you find and fix before anybody asks is administrative. The same omission after a written request is a different conversation entirely.