Please print, sign and return to HR - Acknowledgement of Annual Notices
2021 New Health Insurance Marketplace Coverage (Expires 6/30/2023)
Under the Affordable Care Act (ACA), employers covered by the Fair Labor Standards Act (FLSA) are required to provide a notice to employees about the health insurance marketplace/exchanges of the state(s) in which they operate. Employers have been required to provide this notice to current employees and new employees at the time of hire since Oct. 1, 2013. Employers are not required to provide a separate notice to dependents or other individuals who are or may become eligible for coverage under the plan but who are not employees. New hires must receive the notice within 14 days of the employee's start date. The notice may be distributed electronically or by hard copy. There is no requirement to obtain an employee's signature; however, an employer may want to track delivery and receipt of the notice.
Technical Release No. 2013-02 - see III. Guidance For The Notice to Inforrm Employees of Coverage Options Under the FLSA, B. Providing Notice to Employees
Employers must provide a notice of coverage options to each employee, regardless of plan enrollment status (if applicable) or of part-time or full-time status. Employers are not required to provide a separate notice to dependents or other individuals who are or may become eligible for coverage under the plan but who are not employees.
The notice must inform the employee:
For more information about obtaining coverage through the Marketplace, visit www.healthcare.gov, contact EBSA electronically at www.askebsa.dol.gov, or call the HealthCare.gov Help Line at 1-800-318-2596.
CHIPRA (Children's Health Insurance Program Reauthorization Act of 2009) imposes an annual notice requirement on employers that maintain group health plans in states that provide premium assistance subsidies under a Medicaid plan or a Children's Health Insurance Plan (CHIP). Employers that maintain a group health plan in a State that provides assistance under Medicaid or CHIP must notify ALL employees of potential opportunities for premium assistance in the State in which the employee resides. Signing this acknowledgement indicates you have been notified of this annual notice.
CHIPRA Notice (Expires 1/31/2023)
The Department of Labor (DOL), through its Employee Benefits Security Administration (EBSA), has released a new model Employer CHIP Notice with information current as of July 31, 2020. As a reminder, the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) imposes an annual notice requirement on employers that maintain group health plans in states that provide premium assistance subsidies under a Medicaid plan or a Children’s Health Insurance Plan (CHIP). An employer can choose to provide the notice on its own or concurrent with the furnishing of:
• Materials notifying the employee of health plan eligibility;
• Materials provided to the employee in connection with an open season or election process conducted under the plan; or
• The summary plan description (SPD).
The DOL updates the model notice each year to reflect any changes in the number of states offering premium assistance programs, as well as the contact information for those states.
Medicare Part D Creditable Coverage Notices
Employers who sponsor group health plans that offer prescription drug coverage to Medicare-eligible individuals must provide a Medicare Part D Creditable or Non-Creditable Coverage Notice to those individuals before October 15 (2020).
These notices inform Medicare-eligible individuals whether the plan's prescription drug coverage is expected to pay, on average, as much as the standard Medicare prescription drug coverage (meaning it is "creditable").