Benefits Notices

Within 90 days after the employee becomes a participant in the plan

An updated SPD must be furnished every 5 years if changes are made to SPD information or the plan is amended (otherwise, it must be furnished every 10 years)

Summary of Material Modifications (SMM)

and

Summary of Material Reduction in Covered Services or Benefits

No later than 210 days after the end of the plan year in which the change is adopted for material changes to the plan that do not result in a material reduction in covered services or benefits

Within 60 days of adoption of a material reduction in covered services or benefits (alternatively, notice may be provided with plan information that is furnished at regular intervals of not more than 90 days, if certain conditions are met)

Note: Timely distribution of a “Notice of Modification” (below) may satisfy these requirements.

Plan Documents (e.g., SPD, any SMMs, and other documents under which the plan is established or operated)

Forms 1094-B (Transmittal) and 1095-B (Health Coverage)

Note: For self-insured employers only.

Form 1095-B must generally be furnished to covered individuals by January 31

Forms 1094-B and 1095-B must generally be filed with the IRS by February 28 (or March 31, if filing electronically)

Must be provided at specified times during the enrollment process and upon a participant or beneficiary’s request, generally as follows:

• Prior to initial enrollment in the plan;
• Upon renewal of plan coverage;
• Within 90 days of special enrollment; and
• Within 7 business days following receipt of a request

(The SBC may be provided together with other summary materials such as an SPD, if the SBC information is intact, prominently displayed at the beginning of the materials, and in accordance with the timing requirements for providing an SBC.)

No later than 60 days prior to the effective date of a material plan or coverage change that would affect the content of the SBC and that occurs other than in connection with a renewal or reissuance of coverage

Note: A complete and timely notice may also satisfy the requirement to provide an SMM.

In all plan materials that describe the terms of a health-contingent wellness program (both activity-only and outcome-based wellness programs). For outcome-based wellness programs, this notice must also be included in any disclosure of an individual’s failure to satisfy an initial outcome-based standard.

If the plan materials merely mention that a program is available, without describing its terms, this disclosure is not required.

Notice of Privacy Practices

Note: Fully insured group health plans that do not create or receive protected health information (PHI)—other than summary health and enrollment information—are not required to develop this notice.

Fully insured group plans that create or receive PHI in addition to summary health information and enrollment information must maintain a notice and provide it to any person upon request. Other health plans must provide the notice as follows:

To new enrollees: At the time of enrollment

To individuals covered by the plan: Within 60 days of a material revision to the policy (special rules apply for website notice postings)

A health plan also must notify individuals covered by the plan of the availability of, and how to obtain, the notice at least once every 3 years, and make it available to any person who asks for it.

Upon request for a plan offering medical/surgical benefits and mental health or substance use disorder benefits

Note: Certain plans that are exempt from the MHPAEA requirements based on increased cost may be subject to alternative disclosure rules.

Annually prior to October 15th, upon request, and at various other times as required under the law

An online disclosure to the Centers for Medicare & Medicaid Services (CMS) is also required annually, no later than 60 days from the beginning of a plan year, and at certain other times

Whenever an applicant or employee is sent for a medical examination by an employer with 15 or more employees

An additional “warning” is required when requests for health-related information are made by employers with 15 or more employees (e.g., to support an employee’s request for reasonable accommodation or a request for sick leave), but only if the request for medical documentation is made in a way that is likely to result in receipt of genetic information

Notices of nondiscrimination and taglines that alert individuals with limited English proficiency to the availability of language assistance services are generally required to be posted in: (1) significant publications and communications targeted to beneficiaries, enrollees, applicants, and members of the public; (2) conspicuous physical locations where an entity interacts with the public; and (3) a conspicuous location on the entity’s website, accessible from the homepage of the site.

Note: The content requirements are modified for small-sized significant communications (such as postcards).

May be posted where employers customarily place notices for employees

Must be posted prominently where it can be readily seen by employees and applicants, even if no employees are eligible for FMLA leave

The notice must also be provided to each eligible employee by including it in employee handbooks or other written guidance concerning employee benefits or leave rights (if such written materials exist), or by distributing a copy to each new employee upon hiring, but only if the employer has any FMLA-eligible employees

Generally within 5 business days of the employee notifying the employer of the need for FMLA leave (or when the employer acquires knowledge that an employee’s leave may be for an FMLA-qualifying reason)

Note: Written notice of any change in the employee’s eligibility status, or the specific information provided by the notice of rights and responsibilities, is also required (generally within 5 business days).

Generally within 5 business days after the employer has enough information to determine whether the leave is being taken for an FMLA-qualifying reason (if leave is not designated as FMLA-qualifying, the notice may be in the form of a simple written statement)

Note: Written notice of any change to the information provided in the designation notice is also required, within 5 business days of receipt of the employee’s first notice of the need for leave subsequent to any change.

Form 5500 Annual Return/Report

and

Schedules to Form 5500

Filed electronically with the DOL through the ERISA Filing Acceptance System (EFAST2), using either EFAST2-approved vendor software or the IFILE webbased filing system

Note: The plan administrator must keep a copy of the Form 5500 on file and must make a paper copy available upon request to participants, beneficiaries, & the DOL (see “Plan Documents” above)

Generally by the last day of the 7th calendar month after the end of the plan year (not to exceed 12 months in length)

A plan may obtain a one-time extension of time to file (up to 2½ months) by filing Form 5558 with the IRS on or before the date the Form 5500 would otherwise be due, without extension

Note: Depending on the plan design, certain exemptions may apply.

Plans subject to Form 5500 annual reporting requirements must provide the SAR annually within 9 months after the end of the plan year

Note: When an extension of the due date for filing Form 5500 has been granted by the IRS, the SAR must be provided within 2 months after the extended due date