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Model language is available from the DOL. Under the ACA, non-grandfathered group health plans and issuers that require designation of a participating primary care provider must permit each participant, beneficiary and enrollee to designate any available participating primary care provider including a pediatrician for children.

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If a non-grandfathered plan requires participants to designate a participating primary care provider , the plan or issuer must provide a notice of these patient protections whenever the SPD or similar description of benefits is provided to a participant. Plan administrators must provide an initial COBRA notice to new participants and certain dependents within 90 days after plan coverage begins.

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At or prior to the time of enrollment , a group health plan must provide each eligible employee with a notice of his or her special enrollment rights under HIPAA. The DOL has provided a model notice. Group health plan sponsors must provide a notice of creditable or non-creditable prescription drug coverage to Medicare Part D eligible individuals who are covered by, or who apply for, prescription drug coverage under the health plan.


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This creditable coverage notice alerts the individuals as to whether or not their prescription drug coverage is at least as good as the Medicare Part D coverage. The notice generally must be provided at various times, including when an individual enrolls in the plan and each year before Oct. Health plans are required to send the Privacy Notice at certain times, including to new enrollees at the time of enrollment. Also, at least once every three years, health plans must either redistribute the Privacy Notice or notify participants that the Privacy Notice is available and explain how to obtain a copy.

Self-insured health plans are required to maintain and provide their own Privacy Notices. Special rules, however, apply for fully insured plans.

Other issues

Under these rules, the health insurance issuer, and not the health plan itself, is primarily responsible for the Privacy Notice. Plan administrators must provide an SPD to new participants within 90 days after plan coverage begins. Any changes that are made to the plan should be reflected in an updated SPD booklet or described to participants through a summary of material modifications SMM. Also, an updated SPD must be furnished every five years if changes are made to SPD information or the plan is amended.

Otherwise, a new SPD must be provided every 10 years.

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The plan administrator generally must provide the SAR within nine months of the close of the plan year. If an extension of time to file the Form is obtained, the plan administrator must furnish the SAR within two months after the close of the extension period.

As a general rule, these notices should be provided when the wellness program is communicated to employees and before employees provide any health-related information or undergo medical examinations. A wellness program that simply promotes good health and a healthy lifestyle, does not provide medical care, and is not otherwise part of a group health plan has fewer compliance obligations.

Decide whether to structure a wellness program that provides medical care as a stand-alone plan.

In counseling employers about this choice, note that it may be very challenging to ensure that a stand-alone wellness program complies with applicable group health plan mandates. Offer the participation-only program to all similarly-situated individuals regardless of health status. However, an employer may be able to treat different groups of similarly-situated individuals differently. In addition, an employer may treat a group of similarly-situated employees with an adverse health status more favorably than a group of similarly-situated employees who do not have that adverse health status for example, a reward for completing a health coaching session may be offered only to a group of employees with high blood pressure.

Identify health-contingent aspects of the wellness program. Determine whether a health-contingent program is activity-only or outcome-based.

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This determination impacts when and how a program must provide a reasonable alternative standard for a participant who cannot meet the primary standard. What are the easiest ways they can find and get the care they need? Whether they're entering the workforce or leaving for college, they'll need to prepare. Read the tips below to know what to do. Consider submitting a minor consent form to the college or university health center.

Michigan law requires consent for treatment of most illnesses or injuries to minors.