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Baldwin Bulletin

Question of the Month – September

The Baldwin Group
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Updated: September 24, 2024
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3 minute read

Question:

I have a business with 27 full-time employees, what notices do I need to post or provide to my employees?

Answer:

As defined by the U.S. Small Business Administration, for most industries, a “small business” either in terms of the average number of employees over the past 12 months, or average annual receipts over time.  The business may be a sole proprietorship, partnership, corporation, or any other legal form.

Under the Affordable Care Act of 2010 (“ACA”), small group, for purposes of employer group health insurance, is defined as an organization with 50 or fewer full-time and full-time equivalent employees.

Federal Employment Laws That Apply to Employers With 50 or Less Employees.

The following federal employment laws apply to employers with 50 or less employees:

LawBrief DescriptionResources
Children’s Health Insurance Program (“CHIP”)Employees may be eligible for health coverage from their state via premium assistance program that can help pay for coverage, using funds from Medicaid or CHIP programs.LINK
Consent to Receive Electronic NoticesThe employer should inform the employee that participation in open enrollment and providing an email address, the following documents and/or notices may be done electronically:LINK
 Consolidated Omnibus Benefits Reconciliation Act (“COBRA”) of 1986Summary Plan Descriptions

Summaries of Material Modifications;

Summary Annual Reports;

COBRA Notices;

Summary of Benefits and Coverage;

Notice of Health Insurance Marketplace Coverage Options; and,

Other ERISA required or Model Benefit Notices.

The Consolidated Omnibus Budget Reconciliation Act (“COBRA”) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events.  There are multiple required notices. Please click on the link for model notices.
LINK
Health Insurance Penalties & FinesThe notice should contain information about the health plan offerings to full-time employees (“FTE”) and what is an FTE. Also, language is required that the employers’ health plan [does or does not] meet minimum value coverage and [is or is not] considered affordable.LINK
Notice of Patient ProtectionsNotice of Patient Protections includes the following:

Health care providers and health plans must give individuals a notice that explains how they may use and share your health information, as well as your health privacy rights.

The HIPAA Privacy Rule requires health plans and covered health care providers to develop and distribute a notice that provides a clear explanation of individuals’ rights regarding their personal health information and privacy practices.

Individuals have a right to adequate notice of how a covered entity may use and disclose protected health information, as well as their rights and the covered entity’s obligations.

Providers and facilities must publicly post information about patient balance billing protections and provide patients with a one-page notice outlining these protections.

Plans and issuers are required to provide notice to participants of their rights under section 2719A of the Affordable Care Act.
LINK
Genetic Information Non-Discrimination Act of 2008 (“GINA”)The Genetic Information Nondiscrimination Act of 2008 (“GINA”) protects employees against discrimination based on their genetic information.  Unless otherwise permitted, employers may not request or require any genetic information from employees and their dependents.LINK
Michelle’s Law NoticePursuant to Michelle’s Law, this Notice informs the employee that the employer’s group health plan provides dependent coverage beyond age 26 and bases eligibility for such dependent coverage on student status.LINK
Mental Health Parity & Addiction Equity Act (“MHPAEA”)The Mental Health Parity and Addiction Equity Act of 2008 generally requires group health plans and health insurance issuers to ensure that financial requirements (such as co-pays and deductibles) and treatment limitations (such as annual visit limits) applicable to mental health or substance use disorder benefits are no more restrictive than the predominant medical benefits.LINK
Notice of Special Enrollment RightsHIPAA provides additional opportunities to enroll in a group health plan if an individual loses other coverage or experiences certain life events.LINK
Newborns’ and Mothers’ Health Protection ActThe Newborns’ and Mothers’ Health Protection Act of 1996 (“NMHPA”) is a federal law that affects the length of time a mother and newborn child are covered for a hospital stay in connection with childbirth.LINK
Rights and Protections Against Surprised Medical BillsWhen employees get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, they are protected from balance billing.LINK
Provide a notice to employees that explains their rights, benefits and obligations under USERRA. Employers may provide the notice (“Your Rights Under USERRA”) by posting it where employer notices are customarily placed, handing it out, mailing it or sending it via electronic mail.LINK

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