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.
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 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. Currently, there are 38 participating states. California and Colorado, which have been off and on in recent years, are both included once again.
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.
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.
The DOL has the authority to assess penalties in the event the employer fails to comply with the premium assistance notice requirement. The penalty may be up to $119 per day per affected employee.
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 that 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.
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.
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.
ThinkHR customers have access to a wealth of information about required benefit plan notices in our Comply solution. Not a customer yet? Request a consultation to learn more about Comply and our other turn-key solutions.