With open enrollment in full swing for many employers, now is a good time to review employee benefit communications. Plan sponsors of health plans are generally responsible for properly administering all of the health plan notices required by law, including HIPAA. To ease the administrative burden and to cut costs, these notices can, and often are, included among open enrollment materials. The following is a summary of the HIPAA-related notices that may be included in open enrollment communications.
HIPAA Privacy Notice
HIPAA privacy rules require that health plans or their insurers distribute a notice to participants of their privacy rights. HIPAA requires that plans give the notice to new participants and redistribute it if revised. Notice of availability to receive another copy must also be given every three years. For fully insured plans, the insurer is responsible for providing these notices but may delegate its responsibilities for distribution to the employer.
HIPAA Special Enrollment Rights Notice
The Special Enrollment Rights Notice describes the group health plan’s special enrollment rules, including the right to enroll within 30 days of the loss of other coverage or in the case of marriage, birth of a child, adoption, etc. This notice must be provided at or before the time an employee is initially offered the opportunity to enroll in a group health plan. It must include special enrollment rights related to eligibility for Medicaid and the state Children’s Health Insurance Program (CHIP) coverage.
Wellness Program Disclosures
If a wellness program requires individuals to meet a standard related to a health factor to obtain a reward, the HIPAA nondiscrimination rules require that the program satisfy a disclosure requirement. Examples include wellness programs providing premium discounts for participants who do not smoke or who obtain specific results under a biometric test (for example, body mass index below 30). Any of the open materials describing such programs must disclose that certain individuals may obtain the reward by meeting a reasonable alternative or by obtaining a waiver. This notice must also include contact information for obtaining the alternative and a statement that recommendations of a personal physician will be accommodated.