Employee benefit plan private health record disclosure

Employee Benefit Compliance Notice and Disclosure Rules

This Employee Benefit Compliance Overview summarizes a number of the notice and disclosure requirements that apply to group health plans and employers under federal laws. For example, this overview describes notice and disclosure requirements under:

• The Genetic Information Nondiscrimination Act (GINA)
• HIPAA
• Medicare Part D
• Other federal laws, such as the Women’s Health and Cancer Rights Act (WHCRA)

View the complete Employee Benefit Compliance Chart here. Note that COVID-19-related deadline extension relief may be available for some of these notice and disclosure requirements.

Required Notices

• Group health plan sponsors must comply with numerous reporting and disclosure requirements.
• Each notice or disclosure has its own timing requirements. Some deadlines have been extended due to the COVID-19 pandemic.
• Although some notice and disclosure requirements apply to all employers, others only apply to certain employers.
• Model forms are available for many required disclosures.

Examples on the Employee Benefit Compliance Chart

Some of the main notice and disclosure requirements for group health plans are:

• The summary plan description (SPD)
• COBRA notices
• ACA employee statements
• Medicare Part D notices of creditable coverage
• Form 5500

Notice and Disclosure Rules

COVID-19-Related Deadline Extensions

Due to the COVID-19 pandemic, the DOL has extended the time to furnish benefit statements and other notices and disclosures required under ERISA*, if good faith efforts are made to provide the documents as soon as administratively practicable. These deadlines were initially extended by disregarding an Outbreak Period from March 1, 2020, until 60 days after the announced end of the National Emergency. Under federal law, this period could not exceed one year, meaning that the relief was expected to expire on Feb. 28, 2021.

However, Disaster Relief Notice 2021-01 extends the relief beyond this date in some situations, while emphasizing that plan administrators should continue to make reasonable accommodations to prevent the loss of or delay in payment of benefits. The deadlines for individuals and plans subject to the initial relief are extended until the earlier of:

• One year from the date they were first eligible for relief; or
• 60 days after the announced end of the National Emergency (the end of the Outbreak Period).

On the applicable date, the time frames for individuals and plans with periods that were previously disregarded will resume. In no case will a disregarded period exceed one year.

*Key notices and disclosures required under ERISA include the summary plan description (SPD), summary of material modifications (SMM), summary of benefits and coverage (SBC), Notice of Patient Protections, Notice of Grandfathered Status, wellness program disclosure under HIPAA, CHIP Notice and Women’s Health and Cancer Rights Act Notice.

Links and Resources

• Department of Labor’s (DOL) website regarding compliance assistance for health plans, which includes links to many model forms and notices.
• Internal Revenue Service (IRS) website for tax forms and instructions.
• Center for Medicare and Medicaid Services’ (CMS) website regarding Medicare Part D disclosures.