Annual Notices to Employees
USI faculty and staff need to know the federal, state, University workplace laws
and regulations listed below. USI satisfies the annual notice requirement by
including these notices in your annual open enrollment materials and sending an
electronic reminder to faculty and staff annually to visit the HR web page and
review this information. Some notice requirements are satisfied by insurer
mailings. Other benefits related notices are also available in
poster form in HR and have been added to this web site as well – like
FMLA, COBRA, and others.
The Patient Protection and Affordable Care Act (PPACA) and the Health Care and
Education Reconciliation Act of 2010 contain a number of changes that went into
effect beginning January 1, 2011, for calendar year plans. These changes include
the following.
The Anthem plans are not grandfathered, and the University in 2011 added 100% coverage of preventative services as defined under PPACA,
in keeping with the University’s increased emphasis on wellness. All Anthem plans
have incorporated required changes due to health reform under PPACA including allowing coverage
of dependents to age 26, having no pre-existing conditions for children up to
age 19, ending the plan’s lifetime maximum, and, if applicable, limiting annual
maximums on essential benefits. Specific information regarding these changes can
be found in your Summary Plan Description (SPD).
The following notices can be found in your health plan Summary of Benefits or
Certificate of Coverage:
Newborns’ and Mothers’ Health Protection Act of 1996 (Newborns’ Act):
This notice establishes minimum inpatient hospital stays for newborns and
mothers following delivery.
The Women's Health and Cancer Rights
Act of 1998 (WHCRA): This notice covers required benefits for
mastectomy-related reconstructive surgery, prostheses, and treatment of physical
complications of mastectomy.
Mental Health Parity and Addiction Equity Act of 2008: This
law, which applies to employers with more than 50 employees, extends the mental
health parity laws to substance-use disorders in two ways. First, benefits for
mental health and substance-use disorders must be in parity with
medical/surgical benefits with respect to both the application of aggregate
lifetime and annual dollar limits. Second, plans may not have different
financial requirements (e.g., deductibles, copayments, or coinsurance),
treatment limitations (e.g., number of covered visits and days of inpatient
coverage), or out-of-network coverage limitations for mental health and
substance-use disorder benefits than for medical/surgical benefits.
Claims Review Procedures:
Plan sponsors of group health plans
that are not grandfathered are subject to new claims, appeals and external
review procedures for plan years beginning on or after September 23, 2010. See
attached
Anthem
External Review notice and
Grievances and Appeal notice.
Summary Plan Descriptions:
SECTION 125 FLEXIBLE SPENDING ACCOUNT PLANS
Over-the-Counter Medications:
Beginning January 1, 2011
(regardless of the plan year), expenses for over-the-counter drugs (other than
insulin) cannot be reimbursed under a flexible spending account or health
savings account unless prescribed by a physician. See Nyhart’s notices:
Important Flex Plan Rule
Change and
OTC Drugs and
Medicines.
Dependents to 26: Pursuant to IRS quidance, USI’s flex plan has
been amended to allow flexible spending accounts and health savings account
arrangements to offer tax-advantaged coverage and reimbursements for an
employee's child who has not attained age 27 as of the end of the month of
that birthday.
Special Enrollment Rights: A group health plan must provide
each employee who is eligible to enroll with a notice of his or her HIPAA
special enrollment rights at or prior to the time of enrollment. Each
benefit-eligible employee receives this notice at benefits orientation and each
open enrollment. To review it again, see
Special
Enrollment Rights notice.
Pre-existing Condition Exclusion Notice: Plans that contain
pre-existing condition exclusions, subject to the PPACA limitations, must
provide a notice
describing the exclusions and how prior creditable coverage can reduce the
exclusion period must be provided to participants as part of any written
enrollment materials.
See Pre-existing Condition Exclusion
notice.
HIPPA Privacy Notice:
This notice contains information regarding the handling of your protected health
information (PHI). You also recevied this information via mail from the
health insurer.
HITECH: The Health Information Technology for Economic and
Clinical Health Act (HITECH) makes significant changes to the privacy and
security requirements of HIPAA. HITECH is generally effective February 17, 2010
and includes the following requirements and restrictions. First, HITECH directly
expands privacy and security rules to business associates and their
subcontractors, which may require covered entities to revise their business
associate agreements to comply with the changes. Second, both business
associates and covered entities must comply with new security breach rules that
require notification to the individual whose protected health information was
compromised. Third, a covered entity generally must agree to an individual's
request to restrict disclosures to a health plan, if the protected health
information pertains solely to services for which the provider has been paid out
of pocket in full. Fourth, HITECH imposes new restrictions on disclosures that
prohibit the sale of protected health information and imposes restrictions on
the use of protected health information for marketing purposes. Fifth, several
changes in enforcement have taken place. Civil penalties have been substantially
increased, state attorneys general now have enforcement power, and new
regulations require the sharing of civil penalties with individuals.
OTHER LEGISLATION
Children's Health Insurance Program Reauthorization Act (CHIPRA):
CHIPRA requires group health plans to provide employees
with certain information regarding Medicaid and state health assistance
programs, and to cooperate with government requests for certain plan
information. See CHIPRA notice.
Medicare Part D: Group health plans providing prescription drug
coverage must provide a notice to any individual covered by or eligible for the
group health plan that is eligible for Medicare (an “eligible individual”). The
notice must explain whether the plan’s prescription drug coverage is creditable.
Coverage is creditable if it is actuarially equivalent to coverage available
under the standard Medicare Part D program; both the Anthem Buy-Up and Core
Plans are actuarially equivalent. See
Medicare Part D Creditable
Coverage notice.
COBRA Notice: Plan administrators must provide a written
initial COBRA notice to each employee and his or her spouse when group health
plan coverage first commences of his or her rights under the Consolidated
Omnibus Budget Reconciliation Act of 1986 (“COBRA”). Each benefit-eligible
employee receives this notice upon plan enrollment. To review it again, see
initial COBRA notice.
Qualified Retirement Plans
HEART Act Amendments: Generally, all tax qualified plans, both
defined contribution and defined benefit, had to be amended to comply with the
Heroes Earnings Assistance and Relief Tax Act of 2008 (HEART Act). The two mandatory
HEART Act amendments apply to survivor death benefits and differential wage
payments. A survivor of a participant who died while performing qualified
military service during or after 2007 must receive the same plan benefits,
including death benefits, that would be due if the participant had resumed
employment with the employer and died the following day, including continuous
vesting credit during military leave. Differential wage payments must be
included as compensation for purposes of calculating limitations on maximum
benefits. The University's retirement plans have been amended to meet HEART Act
requirements.