Annual Benefit Notices and Disclosures

From ChamberChoice

Employers who sponsor health plans and other benefits are required to distribute a number of other notices and documents to plan participants or eligible employees. Each document has its own purpose and distribution requirements. The following is a brief list of these notices (note that not every notice may be applicable to every employer):

1. Summary Plan Description (SPD). The purpose of the SPD is to inform participants and beneficiaries about the plan and how it operates. It must be written for an average participant to be sufficiently comprehensive to apprise covered persons of their benefits, rights, and obligations under the plan. 

2. Summary of Material Modifications (SMM). This notice describes material modifications to a plan and changes in the information featured in the SPD. This must be distributed to all plan participants no later than 210 days after the end of the plan year in which the change is adopted. If the change is a material reduction in coverage, it must be provided within 60 days of the effective date of the change.

3. Lifetime Limit Notice. The notice informs eligible plan participants that there is no lifetime limit on the dollar value of benefits under the company’s group health plan. This must be kept for the employer’s records along with information about the health plan.

4. The Dependent Coverage to Age 26 Notice. This notice informs eligible plan participants that they may choose to cover their legally dependent children up to age 26 under the company’s group health plan.

5. Patient Protections Notice. This notice informs eligible plan participants about their rights to choose a primary care provider or a pediatrician when a plan or issuer requires designations of a primary care physician.

6. HIPAA Special Enrollment Rights Notice. The notice informs eligible plan participants about additional opportunities to enroll in a group health plan if they lose other coverage or experience certain life events, commonly referred to as Qualifying Life Events (QLEs). This must be given to eligible employees at or before the time they are offered the opportunity to enroll in the group health plan.

7. Newborns’ and Mothers’ Health Protection Act Notice. This notice explains the protections for eligible plan participants. Group health plans and health insurance issuers may not restrict benefits for a hospital stay in connection with childbirth to less than 48 hours following the vaginal delivery or 96 hours after a delivery by cesarean section. If your company’s coverage is insured by an insurance company or an HMO, and your state has a law controlling coverage for newborns and mothers that meet specific criteria, then the rights and protections depend on the state law.

8. Women’s Health and Cancer Rights Act Notice. This notice explains the protections for eligible individuals who elect breast reconstruction after a mastectomy. Group health plans offering mastectomy coverage must also provide coverage for certain services relating to the mastectomy. Required coverage includes all stages of reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, prostheses, and treatment of physical complications of mastectomy, including lymphedema.

9. Medicaid and Children’s Health Insurance Reauthorization (CHIPRA) Notice. This notice informs eligible plan participants and their children that their state may have a premium assistance program that can pay for coverage using funds from their Medicaid or CHIP programs.

10. HIPAA Notice of Privacy Practices. This notice provides a clear and understandable explanation of the individual’s rights with respect to their personal health information and the privacy practices of health plans and health care providers. The notice must be distributed to all plan participants during enrollment if the employer is subject to HIPAA privacy rules. If there is a revised notice, then the revised notice must be provided within 60 days of the material revision. Individuals who are covered by the plan must be notified of how and where to obtain the notice at least once every three years.

11. Marketplace Notice. This notice helps employees evaluate the different options for health insurance. It provides some basic information about the new Marketplace. The notice should be distributed to all employees on the date of hire.

12. Summary of Benefits and Coverage. Employers who sponsor health plans are required to provide a Summary of Benefits and Coverage (SBC) to employees eligible for health coverage prior to enrollment or reenrollment, and/or upon employee request. The SBC for all available plans must be
provided when the employee is first eligible. The SBC for the plan in which the employee is enrolled should be provided when open enrollment materials are distributed. If open enrollment materials are not distributed, the employer must provide the SBC by the first day the employee is eligible to enroll.

Because there are so many different requirements for document distribution, we recommend that the employer regularly distribute a “Notice Package” that includes all of the above (as applicable) notices and documents.

This article gives a basic overview of recent regulation as in effect on the date of the article. Please be aware that the determination of the requirements and the application of these rules to each employer may differ due to a number of variables. Nothing in this article should be construed as legal advice.

Employers Gather for Conference on Opioids and Drug Abuse

A room full of representatives from several area employers received training and information on several opioid-related topics at the United in Recovery Employer Conference held earlier this month at Geisinger’s Hood Center and organized by the United Way of Columbia and Montour Counties

Sponsors of the event included the Chamber, Pine Barn Inn, Henry Dunn Insurance and Geisinger

The event featured several speakers and breakout sessions on topics such as signs and symptoms of substance misuse, hiring people in recovery, supervisor training and stigma reduction, drug testing in a drug-free workplace, and more. The lunch keynote address was given by Jason Snyder, the regional director of strategic partnerships at Pinnacle Treatment Centers and a former member of the Pennsylvania Department of Drug and Alcohol Programs. He shared his story about substance abuse, which greatly affected both him and his family. 

For more information on United in Recovery, visit its website or contact the United Way at 570-784-3134. 

PA Chamber Stands in Support of Small Business Tax Reform Package

From PA Chamber of Business & Industry

PA Chamber Government Affairs Vice President Sam Denisco joined House and Senate lawmakers and small business owners at a news conference last week in support of a package of bills that aim to help small businesses compete, as well as streamline state and federal tax policies to ease operational burdens for small business owners. 

The “Small Business Tax Fairness Package” includes the following bills that have earned the PA Chamber’s support:

  • H.B. 105 would allow for “like-kind exchanges” that would empower small business owners to defer taxes when property is exchanged for similar property. Notably, Pennsylvania is the only state in the country that does not currently permit this.
  • H.B. 333 would let small businesses take the full expensing deduction the year that an asset for their company is purchased, increasing the deduction from $25,000 to $1 million to match with federal tax law.
  • H.B. 1603 would let small business owners use a net operating loss against a tax bill to get through leaner economic times. This is especially helpful to start-ups or cyclical businesses and is already an option made available to corporate taxpayers under state law.

On Nov. 15, a coalition of business advocates crossing all industry sectors sent a letter to House Finance Committee members urging their approval of these bills.  Two of the bills – H.B. 105 and H.B. 333 – were reported from the committee and await further consideration in the House; while H.B. 1603 still awaits consideration by the committee.

Member News – November 27, 2019

  • Recently, the Danville Primary School in the Danville Area School District joined the Johns Hopkins University’s National Network of Partnership Schools, a nationwide program that helps create excellent schools where families, teachers, staff and community members work together to create successful students. This new designation encompasses many things, one of which is creating home learning areas for children. As part of this initiative, the Primary School is looking to purchase children’s desks for children in the school that may need assistance. If you or your organization is interested in assisting with this goal, please see the flyer, and for additional information or questions, contact June Heeter by email or at 570-394-8413. 

 

  • The Danville Area Community Foundation, an affiliate of the Central Susquehanna Community Foundation, recently announced the creation of the Knouse Family Fund,

    Jean and Richard Knouse

    a donor-advised fund established by Richard and Jean Knouse in honor of their 50th wedding anniversary that will provide grants for charitable purposes in the Danville area and surrounding communities. Read more about Richard and Jean Knouse and this new fund in the full story

 

  • BNI Central Pennsylvania, the Chamber’s newest member, will host an informational interest meeting for those interested in possibly becoming a part of a new chapter in Bloomsburg. The meeting will take place on Wednesday, Dec. 4, from 7-9 a.m., at the Hampton Inn Bloomsburg. See the Facebook event page for additional information and registration. 

 

  • The Northeastern Pennsylvania Industrial Resource Center (NEPIRC) will hold a free four-hour seminar on leadership development on Thursday, Dec. 12, from 8 a.m. – 12 p.m. at the Central Susquehanna Community Foundation, 725 Front St., Berwick. This program helps individuals become stronger, more impactful leaders. While joining other managers and supervisors to discuss workplace challenges, attendees will explore topics that include Self-Awareness, Power & Authority, Risk & Failure, and Leadership Style. Using self-assessment tools and experiential learning, attendees will examine their strengths and weaknesses while exploring best practices of exceptional leaders. To register, and for a list of other locations of similar seminars, visit NEPIRC’s registration page

 

  • Wild For Salmon will host a holiday tasting on Saturday, Dec. 14, from 9 a.m. – 3 p.m. at its retail store located at 521 Montour Blvd. (Rt. 11), Bloomsburg. There will be samples of various holiday-inspired dishes and other festive samples available, as well as a couple of other vendors there as well. Visit the Facebook event for more information. 

 

  • The dealerships that make up the Ken Pollock Auto Group, including Ken Pollock Ford Lincoln in Berwick, will be holding their annual coat drive through Dec. 17. They will be collecting gently used and new coats in all dizes at their dealerships and tire and auto center to help families in the local communities. All donations collected at Ken Pollock Ford Lincoln will go to Columbia County Head Start.

Chamber Supports Telemedicine Legislation

Legislation that would allow health care professionals to evaluate and treat patients remotely has been approved by both chambers of the State Legislature. Telemedicine is expected to improve access to health care, particularly specialists, and help control costs. The Chamber joined with Commonwealth Health and Geisinger in supporting this legislation.

Despite outstanding primary care facilities in our area, rural areas, and a lack of public transportation for the general public, can make access a challenge for a significant portion of the population. Additionally, wait times for specialized services, including behavioral health, can be months. Telemedicine would provide quicker access to services that could be life-saving.

Another benefit of telemedicine expressed by the health care industry is cost-control. Telemedicine is expected to reduce emergency room visits and expedite testing and diagnosis. Senate Bill 857 provides for appropriate insurance reimbursement for services that help patients more efficiently.

The legislation was approved by the Senate in later October with only one dissenting vote. An amended version passed in the House in November by a 111-77 vote. Representatives Kurt Masser and David Millard voted in favor. The amended bill is now back in the Senate for a concurrence vote.