Health Care Reform Update: Model Notices
July 22, 2010
The Department of Labor ("DOL") has issued model notices that include background information and model language that may be used to satisfy the new notice obligations relating to:
(1) the extension of dependent coverage to age 26;
(2) the prohibition on lifetime dollar limits on essential health benefits; and,
(3) certain patient protections.
The model notices are available online on the DOL website (see links to the website under the description of each of the notices below).
Dependent coverage for children under age 26. Children who are (or become) eligible for this coverage must be provided written notice of their enrollments rights and given 30 days to enroll, by no later than the first day of the first plan year beginning on or after September 23, 2010. Coverage must be effective as of the first day of the plan year, even if the required 30-day enrollment period extends into the first month of the plan year. Plans and insurers can avoid having to administer retroactive coverage by providing the required notice not less than 30 days before the beginning of the plan year.
Lifetime limits. Individuals who reached a lifetime limit under a group health plan or insurance coverage before the prohibition on lifetime limits became effective, and who are otherwise still eligible under the plan or coverage, must be given a written notice that the lifetime limit no longer applies. Individuals who are no longer enrolled must be provided a written notice not later than the first day of the first plan year beginning on or after September 23, 2010 informing them of the 30-day enrollment opportunity.
The notices relating to dependent coverage to age 26 and lifetime limits may be included with open enrollment materials, so long as the notices are prominent (like this).
Patient protections. If a group health plan or insurance policy requires or allows an enrolled individual to designate a primary care provider, the plan or insurer must notify enrollees of their rights to (1) choose a primary care provider or a pediatrician from within the plan's network; or (2) obtain obstetrical or gynecological care without prior authorization. This notice must be provided whenever the plan or insurer provides a participant with a summary plan description or other similar description of benefits, starting no later than the first day of the first plan year beginning on or after September 23, 2010.