Employers that sponsor group health plans should provide certain benefit notices in connection with their plans' open enrollment periods. Some of these notices must be provided at open enrollment time, such as the Summary of Benefits and Coverage (SBC).
Other notices, such as the Women's Health and Cancer Rights Act (WHCRA) notice, must be distributed annually. Although these annual notices may be provided at different times throughout the year, employers often choose to include them in their open enrollment materials for administrative convenience. Some of these notices may be included in the plan's Summary Plan Description (SPD) or detailed benefits summary provided by a health insurance issuer or third-party administrator (TPA).
In addition, employers should review their open enrollment materials to confirm that they accurately reflect the terms and cost of coverage. In general, any plan design changes for 2026 should be communicated to plan participants either through an updated SPD or a Summary of Material Modifications (SMM).
Summary of Benefits and Coverage (SBC)
Applies to: Group health plans and health insurance issuers
Group health plans and health insurance issuers are required to provide an SBC to applicants and enrollees each year at open enrollment or renewal time. Federal agencies have provided a template for the SBC, which health plans and issuers are required to use.
The issuer for fully insured plans usually prepares the SBC. If the issuer prepares the SBC, an employer is not required to prepare an SBC for the health plan, although the employer may need to distribute the SBC prepared by the issuer.
Medicare Part D Notice
Applies to: Employers with group health plans that provide prescription drug coverage
Employers must notify Medicare Part D-eligible individuals before Oct. 15 each year about whether the drug coverage is at least as good as the Medicare Part D coverage (in other words, whether the prescription drug coverage is "creditable" or "noncreditable").
Because employers may not be able to identify which individuals are eligible for Medicare Part D, they often provide the Medicare Part D disclosure to all plan participants. Employers will satisfy the timing requirements for this notice if it is provided to all plan participants annually, prior to Oct. 15 of each year.
WHCRA Notice
Applies to: Group health plans that provide medical and surgical benefits for mastectomies
Group health plans must provide a notice about the WHCRA's coverage requirements at the time of enrollment and on an annual basis after enrollment. The annual WHCRA notice can be provided at any time during the year. It is often included in the plan's SPD or benefits summary provided by the plan's issuer or TPA.
Children's Health Insurance Program (CHIP) Notice
Applies to: Group health plans that cover residents in a state that provides a premium assistance subsidy under a Medicaid plan or CHIP
If an employer's group health plan covers residents in a state that provides a premium subsidy under a Medicaid plan or CHIP, the employer must send an annual notice about the available assistance to all employees residing in that state. The annual CHIP notice can be provided at any time during the year.
Summary Plan Description (SPD)
Applies to: Group health plans subject to ERISA
An SPD must be provided to new health plan participants within 90 days of the date their plan coverage begins. Employers may include the SPD in their open enrollment materials to make sure employees who newly enroll receive the SPD on a timely basis.
An updated SPD must be provided to participants at least every five years if material modifications have been made during that period. If no material modifications have been made, an updated SPD must be provided at least every 10 years.
COBRA General Notice
Applies to: Group health plans subject to COBRA (employers with 20+ employees)
Group health plans must provide a written General Notice of COBRA Rights to covered employees within 90 days after their health plan coverage begins. Employers may include the General Notice in their open enrollment materials to ensure that employees who newly enroll during open enrollment receive the notice on a timely basis.
Grandfathered Plan Notice
Applies to: Group health plans maintaining grandfathered status
To maintain a plan's grandfathered status, the plan sponsor must include a statement of the plan's grandfathered status in plan materials provided to participants describing the plan's benefits (such as the SPD and open enrollment materials).
HIPAA Privacy Notice
Applies to: Self-insured group health plans
The HIPAA Privacy Rule requires self-insured health plans to maintain and provide their own Privacy Notices. Special rules apply for fully insured plans — the health insurance issuer, not the health plan itself, is primarily responsible for the Privacy Notice.
Self-insured health plans are required to send Privacy Notices at certain times, including to new enrollees at the time of enrollment. At least once every three years, health plans must either redistribute the Privacy Notice or notify participants that it is available and explain how to obtain a copy.
Special rules for fully insured plans: The sponsor of a fully insured plan has limited responsibilities. If the sponsor has access to PHI for plan administrative functions, they must maintain a Privacy Notice and provide it upon request. If the sponsor does not have access to PHI for plan administrative functions, they are not required to maintain or provide a Privacy Notice.
HIPAA Special Enrollment Notice
Applies to: All group health plans
At or prior to the time of enrollment, a group health plan must provide each eligible employee with a notice of their special enrollment rights under HIPAA. This notice is often included in the health plan's SPD or benefits summary provided by the plan's issuer or TPA.
Summary Annual Report (SAR)
Applies to: Group health plans subject to Form 5500 filing requirements (unfunded health plans are exempt)
Health plans that are required to file Form 5500 must provide participants with a narrative summary of the information in Form 5500, called an SAR. The plan administrator generally must provide the SAR within nine months of the close of the plan year. If an extension of time to file Form 5500 is obtained, the plan must furnish the SAR within two months after the close of the extension period.
Wellness Notice — HIPAA
Applies to: Group health plans with health-contingent wellness programs
Employers with health-contingent wellness programs must provide a notice that informs employees that there is an alternative way to qualify for the program's reward. This notice must be included in all plan materials that describe the terms of the wellness program.
Wellness Notice — ADA
Applies to: Wellness programs that collect health information or include medical exams
To comply with the Americans with Disabilities Act (ADA), wellness plans that collect health information or involve medical exams must provide a notice to employees that explains how the information will be used, collected and kept confidential. Employees must receive this notice before providing any health information and have enough time to decide whether to participate.
Individual Coverage HRA (ICHRA) Notice
Applies to: Employers that sponsor ICHRAs
Employers may implement an ICHRA to reimburse eligible employees for insurance policies purchased in the individual market or for Medicare premiums. Employers with ICHRAs must provide a notice to eligible participants about the ICHRA and its interaction with the ACA's premium tax credit. This notice must be provided at least 90 days before the beginning of each plan year.
This Compliance Overview is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice. © 2021-2025 Zywave, Inc. All rights reserved.