Planning on Making Changes Outside of Open Enrollment?
The Affordable Care Act (ACA) requires an employer offering Group Health Insurance coverage to provide all enrolling employees with a minimum 60-day notice of any material plan modifications during the plan year (outside of renewal), prior to the planned effective date.
- Section 102 of ERISA law includes any modification to the coverage that would be considered by an average plan participant to be an important change – including a change in covered benefits or other terms of coverage under the plan or policy. It also includes any enhancement of covered benefits, services, or other, more general plan or policy terms (such as previously excluded benefits or reduced cost sharing).
- The requirement does not apply to renewals or carrier issued modifications made as part of a planned renewal.
- Because of the 60-day notice requirement, renewal change submissions must be timely or the health plan could be required to delay the effective date.
Plan issuers or sponsors intentionally failing to provide appropriate notice are subject to a fine for each failure.