For companies of all sizes, this chart provides an overview of key required benefits notices and filings for employers and plan administrators under federal law. Please note that your company may be exempt from certain requirements and/or subject to additional obligations under your state's laws. Employers are encouraged to contact the U.S. Department of Labor or a knowledgeable employment law attorney for further guidance.
|Notice||Provide To||When Due|
|Summary Plan Description (SPD)||Group health plan participants||
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)
Summary of Material Reduction in Covered Services or Benefits
|Group health plan participants||
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)
|Group health plan participants & beneficiaries||Copies must be furnished within 30 days of a written request, and the plan administrator must make copies available for examination at its principal office (the DOL can also request any documents relating to the plan)|
|Notice||Provide To||When Due|
Forms 1094-B (Transmittal) and 1095-B (Health Coverage)
Note: For self-insured employers only.
|Responsible individuals enrolled in self-insured coverage (may be the primary insured, employee, former employee, or other related person named on the application)||
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)
|Health Insurance Exchange Notice||All new employees||Within 14 days of an employee’s start date|
|Summary of Benefits and Coverage (SBC) & Uniform Glossary||Group health plan participants & beneficiaries||
Must be provided at specified times during the enrollment process and upon a participant or beneficiary’s request, generally as follows:
(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.)
|Notice of Modification||Group health plan participants & beneficiaries||
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.
|Disclosure of Grandfathered Status||Group health plan participants & beneficiaries||In any plan materials for a grandfathered group health plan provided to a participant or beneficiary describing the benefits provided under the plan|
|Notice of Patient Protections||Group health plan participants||Whenever a participant in a non-grandfathered group health plan requiring or providing for the designation of a participating primary care provider is furnished an SPD or other similar description of plan benefits|
|Patient-Centered Outcomes Research Institute (PCORI) Fees||Filed with the Internal Revenue Service||IRS Form 720 must be filed annually by plan sponsors of certain self-insured health plans, no later than July 31st of the calendar year immediately following the last day of the plan year to which a fee applies|
|Notice||Provide To||When Due|
|Notice of Special Enrollment Rights||Employees eligible to enroll in the employer’s group health plan||At or before the time an employee is initially offered the opportunity to enroll in the plan|
|Wellness Program Disclosure||Group health plan participants & beneficiaries eligible to participate in a health contingent wellness program||
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.
|Individuals enrolled in the plan||
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.
|Notice||Provide To||When Due|
|Women’s Health & Cancer Rights Act (WHCRA) Notices||Group health plan participants & beneficiaries||Upon enrollment in a plan that provides coverage for medical and surgical benefits related to a mastectomy, and annually thereafter|
|Mental Health Parity & Addiction Equity Act (MHPAEA) Disclosure||Any current or potential group health plan participant, beneficiary, or contract provider||
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.
|Employer Children’s Health Insurance Program (CHIP) Notice||All employees in states with group health plan premium assistance||Annually before the start of each plan year (may be provided with enrollment packets, open season materials, or the SPD)|
|Michelle’s Law Notice||Group health plan participants||With any notice regarding a student status certification requirement under a plan that bases coverage eligibility on student status (and that provides dependent coverage beyond age 26)|
|Newborns’ and Mothers’ Health Protection Act Notice||Group health plan participants||Must be included in the SPD for a plan providing maternity or newborn infant coverage|
|Medicare Part D Creditable Coverage Disclosure Notice or Non-Creditable Coverage Disclosure Notice||Medicare-eligible individuals (including certain dependents) who are offered prescription drug coverage under the employer’s group health plan||
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
|Genetic Information Nondiscrimination Act (GINA) Disclosures||Entities from whom requests for health related information are made—only applicable to requests by employers with 15 or more employees||
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
|ADA Notice Regarding Wellness Program||All employees offered participation in a wellness program that collects employee health information—only applicable to employers with 15 or more employees||Must be provided before the employee provides any health information, with enough time for the employee to decide whether to participate in the program|
|ACA Section 1557 Nondiscrimination Notice & Taglines||Beneficiaries, enrollees, applicants, and members of the public that participate (or may participate) in certain health programs or activities that receive federal financial assistance||
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).
|Uniformed Services Employment and Reemployment Rights Act (USERRA) Notice||All employees||
May be posted where employers customarily place notices for employees
|Qualified Small Employer HRA (QSEHRA) Notice||Eligible employees of employers that had fewer than 50 full time employees in the preceding calendar year that do not offer a group health plan, and that fund a QSEHRA||Generally no later than 90 days before the beginning of the year in which the QSEHRA is funded. In the case of a newly eligible employee, the initial written notice must be furnished on or before the first day the employee becomes eligible to participate in the QSEHRA.|
|Notice||Provide To||When Due|
|General FMLA Notice||All 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
|Notice of FMLA Eligibility & Rights and Responsibilities||Employees requesting FMLA leave||
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).
|FMLA Designation Notice||Employees requesting FMLA leave||
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.
|Employers With 100+ Employees Also Need To Comply With:|
Form 5500 Annual Return/Report
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.
|Summary Annual Report (SAR)||Each plan participant||
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