Document Name

Information Type

Recipients

Timing

Summary of Material Reduction in Covered Services or Benefits

-Synopsis of changes that are a “material reduction in covered services or benefits.”

-Participants

-Normally within 60 days of adoption of material reduction in group health plan services or benefits.

-The regulations have an alternative 90-day rule.

Initial COBRA Notice

-Notice to employees of their right to purchase limited-time extension of group health coverage when employees lose the coverage because of a qualifying event.

-Covered employees and covered spouses.

-At the commencement of the group health plan coverage.

COBRA Election Notice

-Notice of the right to elect COBRA coverage upon occurrence of qualifying event sent to “qualified beneficiaries.”

-Covered employees, covered spouses, and dependent children who are qualified beneficiaries.

-Under normal circumstances, the notice must be provided by the administrator to qualified beneficiaries within 14 days after being informed by the employer or qualified beneficiary of the occurrence of a qualifying event.

Certificate of Credible Coverage

-Proof of prior group health plan creditable coverage from employee’s former plan.

-Participants and beneficiaries who lose coverage.

-Due automatically when group health plan coverage is lost, when gaining eligibility for COBRA coverage, and when COBRA coverage ends. A request for a certificate may be made, free of charge up until 24 months after losing coverage.

Conversion Notices

-Notice to “qualified beneficiaries” that when continuation coverage expires, he or she can enroll in a conversion health plan.

-Certain COBRA qualified beneficiaries if plan provides conversion option.

-Must be offered during the 180-day period that ends when continuation coverage expires.

General Notice of Preexisting Condition Exclusion

-Notice describing a preexisting condition exclusion, and how creditable coverage reduces the preexisting condition exclusion period.

-Participants

-Notice must occur before the preexisting condition exclusion applies to any individual.

-Notice may be made in a plan’s enrollment materials.

Individualized Notice of Period of Preexisting Condition Exclusion

-Determination that a preexisting condition exclusion period applies to an individual.

-It must also explain appeal procedures an individual must follow to challenge this determination.

-Participants and beneficiaries that do not have creditable coverage that will prevent the preexisting condition exclusion applying.

-Within a reasonable time after evidence of prior creditable coverage has been given by the participant or covered dependent.

Notice of Special Enrollment Rights

-Notice describing the plan’s special enrollment rules, including the right to special enroll within 30 days of the loss of other coverage or of marriage, birth of a child, adoption, or placement for adoption.

-Employees eligible for enrollment in a group health plan.

-At the time or before an employee is offered an opportunity to enroll in the group health plan.

Women’s Health and Cancer Rights Act (WHCRA) Notices

-Notice of required benefits for reconstructive surgery, prostheses, and treatment of physical complications related to mastectomy.

-Participants and beneficiaries.

-Must be provided upon enrollment, and annually

Medical Child Support Order (MCSO) Notice

-Notification regarding receipt and qualification status of a medical child support order that directs the plan to provide coverage to a participant’s non-custodial children.

-Participants, any child named in a MCSO and his or her representative.

-Administrator, upon receipt of MCSO, must promptly issue notice and the procedures followed to determine its qualified status.

-Must also issue separate notice as to whether the MCSO is qualified within a reasonable time after its receipt.

National Medical Support (NMS) Notice

-Notice issued by State agency that is responsible for enforcing health care coverage provisions in a Medical Child Support Order (MCSO).

-Sometimes an employer may be required to complete and return Part A of the NMS notice to the State agency, or transfer Part B of the notice to the plan administrator to obtain a determination on whether the notice is a qualified MCSO.

-Employers, state agencies, plan administrators, participants, custodial parents, children, representatives.

-Within 20 days after the date of the notice, the employer must either submit Part A of the notice to the State agency or Part B to the plan administrator.

-Upon receipt of the notice, the administrator must inform affected persons of the receipt the notice and the procedures for determining its qualified status.

-Administrator must complete and return Part B to the State agency and provide required information to affected persons within 40-business days.

-The state agency may also require an employer to submit Part A after processing Part B.