Department of Labor

DOL Updates the Employer CHIP Notice | North Carolina Employee Benefits

The U.S. Department of Labor (DOL) has updated the model notice for employers to use to inform employees about the Children’s Health Insurance Program (CHIP). All employers with group health plans are required to distribute a CHIP notice at least once a year to employees living in certain states. There is no need to send another notice to workers who received the prior version in the past year, but employers should use the updated notice going forward. This also is a good time for employers to review their procedures for distributing CHIP notices.

The following are the most frequently asked questions we receive from employers about CHIP notices.

Frequently Asked Questions

What is the purpose of the CHIP notice?
The CHIP notice informs benefits-eligible employees that their state’s CHIP or Medicaid program may offer premium assistance to help them pay for group health coverage at work. Many states offer some form of premium assistance to residents based on their family income. The updated notice includes contact information for each participating state (currently 37 states) and explains that persons approved for premium assistance have a special 60-day enrollment period to join their employer’s group plan without having to wait for the employer’s next annual enrollment period.

Does the CHIP notice requirement affect all employers?
All employers that offer a group health plan providing medical benefits, whether insured or self-funded, must consider the CHIP notice requirement. Each employer then will determine if it must distribute the notice depending on whether any of its employees live in one of the states listed in the notice.

Further, all group health (medical) plans must offer a special 60-day enrollment period when an employee becomes eligible for premium assistance (for the employee or a family member) from a state’s CHIP or Medicaid program.

Is the notice required for all employees or just for those enrolled in our group health plan?
The notice must be given to all employees living in any one of the listed states and eligible for the employer’s group health plan, whether or not currently enrolled. That is the minimum requirement. Many employers, however, choose to distribute the notice to all employees, regardless of benefits eligibility or location, to avoid the need for separate distributions when an employee’s status or location changes.

How do we prepare and distribute the notice? How often?
The DOL provides a model notice that employers can copy and distribute. Although employers have the option of creating their own notice to list only the states where their employees are located, most employers simply use the DOL model notice as it is. The model notice also is available in Spanish.

The notice must be distributed when employees initially become eligible for the employer’s health plan and then at least once a year thereafter. For convenience, most employers provide the notice at the same time as they distribute new hire materials and annual enrollment materials.

When combined with other materials, the CHIP notice must appear “separately and in a manner which ensures that an employee who may be eligible for premium assistance could reasonably be expected to appreciate its significance.” For instance, the notice may be a loose item in the same envelope with other material. If the notice is stapled inside other material, however, there should be a note on the top page or cover alerting the reader to the placement of the CHIP notice and its importance.

Do we have to mail out paper copies or can we distribute the notice electronically?
The notice may be sent by first-class mail. Alternatively, it can be distributed electronically if the employer follows the DOL’s guidelines for electronic delivery of group health plan materials. That means that the employer first must determine whether the intended recipient has regular access to the electronic media system (e.g., email) as an integral part of his or her job. If so, the notice can be sent electronically provided the employer takes steps to ensure actual receipt, along with notifying the employee of the material’s significance and that a paper copy is available at no cost.

For persons who do not have regular access to the electronic media system, the notice cannot be sent electronically unless the intended recipient provides affirmative consent in advance. The guidelines for obtaining advance consent are fairly cumbersome, so employers are advised to distribute paper copies in these cases.

Summary

Employers offering group health plans are encouraged to review their procedures for distributing CHIP notices. At a minimum, the notice must be given annually to all employees eligible for the employer’s health plan who live in any of the states listed in the notice. Many employers choose to distribute the notice to all workers in an abundance of caution. The DOL provides model notices in English and Spanish that do not need any customization, so employers can simply copy and distribute one or both versions as needed.

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A DOL Audit Can Happen to You | North Carolina Benefit Advisors

Summary plan descriptions (SPDs) are required for all retirement, health, and welfare plans subject to the Employee Retirement Income Security Act of 1974 (ERISA). However, misconceptions about this requirement are widespread. ERISA attorney Stacy H. Barrow, partner with Marathas Barrow Weatherhead Lent LLP, had a chat with ThinkHR about the importance of having proper ERISA documentation and the consequences of failing to do so.

THR: What types of employers need to have an SPD?

SHB: We tell all employers — of any size — who offer plans subject to ERISA that they need to have an SPD. This is the first item in every Department of Labor (DOL) audit. If you don’t have one and you get audited or a participant asks for plan documents, you will be scrambling to put documents together and you can’t do them fast enough to avoid an issue. In addition, cafeteria plans can only be adopted prospectively, so if you don’t have a written cafeteria plan in place, you may be jeopardizing the tax qualified status of your plan.

THR: Won’t my broker or carrier take care of these documents?

SHB: Employers may think that brokers or carriers take care of all required benefits documentation, but at the end of the day, it’s the employer who is responsible for complying with ERISA’s SPD requirement. Your broker may help you, but they might not be aware of every benefit you offer or your eligibility guidelines. The carrier’s documentation often is missing some of the required language, which is why you use a wrap. You don’t specifically have to use a wrap to develop your SPD, but the carrier document won’t get you there and an wrap is often the best way to comply. If the plan documents aren’t compliant, that’s not the carrier’s or broker’s responsibility, it’s the employer’s.

THR: Do I really need to be concerned about a DOL audit?

SHB: Employers can get complacent about documentation, thinking that only large employers get audited, or it won’t happen to them. It’s not only the large corporations that get audited. It can happen to employers of any size or type. It’s important to make sure you have good benefits documentation, because if you don’t, and you do get audited, it might cause the DOL to dig deeper and look for other problems, such as looking into your 401(k) plan.

Plan documentation is a huge part of every DOL audit. I can’t stress strongly enough that they will want to see the summary plan description and plan documents. If you can get good, compliant documents to the DOL, it increases the chances of a speedy resolution. If you can provide them quickly, it sends a message that you are ready and in compliance.

THR: What are the consequences of being out of compliance?

SHB: Not having the proper documents may be an issue if you get audited or there is litigation over a denied claim. You need to be prepared for this possibility. If the DOL audits and imposes penalties, it may not be because the employer didn’t have a wrap document, but rather because the document wasn’t updated, wasn’t compliant, or wasn’t distributed to employees. And the DOL may impose penalties of up to $152 per day for failure to provide an SPD upon request. Also, failure to inform participants of plan changes may invalidate those changes.

Originally published by www.thinkhr.com

 

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