Legal Requirements and Regulations

There are various legal regulations surrounding open enrollment and benefits communication. Key areas to ensure compliance include: 

• ACA Notices 
• Provide required notices like: 
• Summary of Benefits and Coverage (SBC) 
• Marketplace coverage options and notice of possible premium assistance 
• Notice of grandfathered status if applicable 
• Women’s Health and Cancer Rights Act notice 

Let’s break down the specific regulations to keep top of mind: 

Affordable Care Act (ACA) 

ACA regulations require employers to provide a Summary of Benefits and Coverage (SBC), outlining plan details. 

Employee Retirement Income Security Act (ERISA)  

ERISA governs disclosures like Summaries of Material Modifications (SMM), explaining any plan changes. Failure to meet ERISA obligations can result in fines and penalties. Ensure that doesn’t happen by: 

• Providing Summary Plan Descriptions (SPD) 
• Giving plan participants Summaries of Material Modifications (SMM) if changes occur 
• Ensuring participants receive any required documents in a timely manner 

Consolidated Omnibus Budget Reconciliation Act (COBRA) 

COBRA mandates notifications about health insurance continuation rights. Avoid costly litigation and ensure you comply with COBRA regulations by:  

• Sending initial COBRA notice within 44 days of plan start 
• Providing notice of qualifying events within 30 days 
• Offering election periods and payment schedules as required 

Health Insurance Portability and Accountability Act (HIPAA) 

HIPAA governs rules around the privacy of health information and violations can lead to significant penalties. Protect employee health information by: 

• Safeguarding all health data in communication 
• Encrypting emails and other electronic messages 
• Limiting the disclosure of health information to those who need it 

Non-Discrimination Rules 

Violation of non-discrimination rules can result in legal actions. Ensure open enrollment communication does not discriminate based on: 

• Age 
• Race 
• Gender 
• Disability 
• Religion 
• National origin  

Reporting and documentation 

Maintaining documentation is essential in case of audits or disputes. Keep detailed records of all open enrollment communication efforts, including: 

• Dates of communication 
• Content shared 
• Distribution lists and channels used 
• Receipt confirmations 
• Legal guidance and compliance checks 

Companies must ensure their open enrollment details and materials comply with all relevant laws and regulations. Consulting legal counsel is highly recommended.