Health Reform Checklist For Open Enrollment: Things to Keep in Mind

Health Reform Checklist for Open Enrollment

If your health plan renews on January 1, 2011, you’ll need to tell your employees about several important changes, including two special enrollment periods, as a result of the Patient Protection and Affordable Care Act (“PPACA”), otherwise known as the healthcare reform law.  These changes go into effect for all health plans renewing on or after September 23, 2010.  Assuming your open enrollment period is now or coming very soon, it makes sense to include this information with other open enrollment materials.

First, determine whether your plan is grandfathered or non-grandfathered.  See the article What Is A Grandfathered Plan? for more details.

Notices For Both Grandfathered and Non-Grandfathered Plans:

Notice of Grandfathered Status – Plan participants need to be made aware of whether or not the plan is grandfathered.  See the model notice language Word document issued by the HHS.

Special Enrollment Notice for Child Dependent Coverage Up to Age 26 – For plans that provide dependent coverage, newly eligible children will have a one-time 30-day opportunity to enroll in the coverage, if they:

  • had originally lost coverage due to reaching the prior age limit
  • are on COBRA due to losing coverage
  • or were never covered because they were above the age limit.

Note that some states already have laws in place with the same or higher age limits than this new federal law.  If you have a grandfathered plan, you don’t need to allow adult children who are eligible for coverage through their own job until 2014.  See the model notice language issued by the HHS.

Special Enrollment Notice for Those Who’ve Reached Their Lifetime Limit – The elimination of lifetime dollar limits is one of the PPACA changes.  Therefore, anyone on your plan who lost coverage due to meeting the lifetime dollar limit, and is otherwise still eligible for coverage now has a chance to re-enroll in the plan.  See the model notice language issued by the HHS.   Note:  Only send this special enrollment notice to those who had met the lifetime limit.

Other Plan Changes

Work with your insurance carrier or third party administrator to make sure your summary plan descriptions are updated with the following changes:

Pre-Existing Conditions for Children Under Age 19 – Previously, plans could limit or exclude coverage for pre-existing conditions if the individual did not have prior coverage when they enrolled in the plan.  The PPACA changed this rule so that coverage for pre-existing conditions of children under age 19 could be covered right away.  This provision will eventually be extended to anyone (adults or children) with pre-existing conditions effective 1/1/2014.

 Notice of Rescission of Coverage – The PPACA has limited the reasons that coverage can be revoked retroactively.  Plans are required to give a notice of 30 calendar days when this happens.

Additional Notice for Non-Grandfathered Plans:

Patient Protection Disclosures – For new plans or existing plans that have made changes and are no longer grandfathered, you must notify plan participants of their rights to choose a primary care provider for themselves and pediatricians for their children.  The law also allows obstetrical or gynecological care without prior authorization.  See the model notice language issued by the HHS.

Stay up to date on the latest payroll tips and training

You may also be interested in: