Required Notices for Members

Many ACA provisions require plan sponsors to provide notices to plan members, either in enrollment materials or in a summary plan description. Click on the links below for model notices from the Department of Labor. 

Notices to be provided in summary plan documents: 

• Model Notice of Grandfathered Status – When a plan sponsor elects to maintain a plan’s grandfathered status, it must notify plan members accordingly. 

• Disclosure (not applicable for grandfathered plans) – informs members of their rights to seek care under plans that require the designation of a primary care physician (PCP). Most plans administered by Luminare Health do not require the designation of a PCP, and thus would not be required to provide this notice. 

Here are other notices and Plan document requirements: 

• Exchange Notices – Employers subject to the Fair Labor Standards Act are required to provide all new employees (full time and part time) a notice regarding public health insurance exchanges, also known as health insurance marketplaces, at the time of hire. 
   
  The U.S. Department of Labor considers a notice to be provided at the time of hire if the notice is provided within 14 days of an employee’s start date. 
   
  Federal agencies have issued model notices for employers to use: one for employers who sponsor a health plan and another for employers who do not sponsor a health plan. Both notices, which are available in English and Spanish, can be found on the Department of Labor website. 

• Summary of Benefits and Coverage – Insurers and group health plans are required to produce the annual Summary of Benefits and Coverage (SBC) documents and Glossary of Health Coverage and Medical Terms, beginning Sept. 23, 2012. The SBC is a standardized summary of health plan coverage that is designed using simple language and a consistent format to help employers and members easily compare different plans and understand their health plan. The glossary is a standardized summary of commonly used plan terms. Luminare Health will create the SBC and glossary for plan sponsors of self-funded plans, which will be distributed by employers. 

ACA also requires many new notices related to adverse benefit determination and external review. These notices will be provided to members by Luminare Health on behalf of the plan sponsor.