The Children's Health Insurance Program Reauthorization Act of 2009 was signed into law on February 2009. This is a federal law that will impact group health plans.
The Health Insurance Portability and Accountability Act of 1996 ("HIPAA") requires group health plans to provide special enrollment periods for eligible persons who gain dependents through birth, marriage or adoption, or who lose coverage from another employer. The Children's Health Insurance Program Reauthorization Act of 2009 (“CHIPRA”) requires group health plans to offer a new type of special enrollment period and to provide certain notices to employees.
WHAT THIS MEANS TO YOU AS AN EMPLOYER
New Special Enrollment Events. A group health plan must allow employees and their dependents (if they are otherwise eligible for the plan) to enroll in the plan if either the employee or a dependent loses coverage under the State Children's Health Insurance Program or Medicaid, or the employee or dependent becomes eligible for premium assistance (described below).
- Longer Enrollment Period. Unlike the other HIPAA special enrollment events, which require an enrollment period of at least 30 days, the new special enrollment events require an enrollment period of at least 60 days.
- Employers should ensure that HR personnel and/or third-party administrators responsible for administering enrollment in the group health plan and cafeteria plan are aware of these new enrollment rights.
- Premium Assistance. As a way to encourage enrollment in employer-sponsored health plans, CHIPRA permits states to offer a premium assistance subsidy. Where a state offers a subsidy, the state may choose to pay the subsidy directly to an employer unless the employer has elected not to receive the subsidy. In that event, the state would pay the subsidy to the employee as a reimbursement.
- Required Notice. Employers must provide a notice about the potential opportunity for premium assistance to each employee who lives in a state that provides such assistance. State-specific model notices have not been released by federal regulators. CHIPRA requires the U.S. Department of Health and Human Services (HHS) to provide state-specific model notices by November 4, 2010.
- Effective Dates. The special enrollment period must be offered to employees no later than April 1, 2009. As for the CHIRPA notices, however, such notices are not required to be delivered to employees until the first plan year that begins after the state-specific model notices are issued by the HHS.
WHAT SHOULD I DO NEXT?
Health and cafeteria plans may need to be amended by April 1, 2009 to reflect the new HIPAA special enrollment rights and enrollment period. Although summary plan descriptions ("SPDs") generally do not need to be updated in advance of a change, an SPD may need to be updated by April 1, 2009 if it is used as (or if its HIPAA terms are incorporated by reference in) the plan document.
Communications and plan information disseminated after April 1, 2009 should be updated to reflect these new special enrollment rights. If you have any additional questions regarding the information within this eCommunication, please call Corporate Synergies at 1.866.CSG.1719 or click here to contact us today. |
