Employers, Group Health Plans Subject To New CHIP/Medicaid Notice, Coordination of Benefits & Special Enrollment Requirements

February 16, 2010

By Cynthia Marcotte Stamer

On February 14, 2010, the U.S. Department of Labor (DOL) issued a model notice (CHIP Notice) for employers and unions sponsoring health plans in states offering Medicaid or Children’s Health Insurance Program (CHIP) participants group health plan premium subsidy assistance to inform employees of Medicaid and CHIP premium subsidy opportunities available in their state of residence.  The duty to provide notice is part of various new obligations imposed on group health plans and employers under the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

Covered health plans and health insurers, their sponsoring employers and unions, fiduciaries, administrations and other contracted service providers should take steps to update their employee benefit plan enrollment and coordination provisions, communications, processes and procedures to comply with these new requirements including, where applicable and permitted, specific policies and procedures defining when and how premium subsidies may be paid to the group health plan.  Continue reading.

Other Changing Health Plan Requirements Also Merit Attention

Employer and other group health plans sponsors, insurers, fiduciaries, administrators and service providers should timely update their group health plan terms, practices, notices, policies and procedures in response to these new requirements.  At the same time, health plans, their employer or other sponsors, insurers, fiduciaries, administrators and service providers also should not overlook the need to review and update their health plans in response to a host of other changes in federal health plan mandates. The highly volatile health plan regulatory environment makes it likely that many health plans are not appropriately updated to comply with these and other federal requirements. In recent months, health plans, their employer or other sponsors, administrators and others also have become obligated to comply with a host of other expanded federal health plan rules and requirements. See e.g., New Mental Health Parity Regulations Require Health Plan Review & Updates; New Labor Department Rule Allows Employers 7 Days To Deliver Employee Contributions To Employee Benefit Plans; Newly Extended COBRA Subsidy Rules Require Employers, Administrators Send Required Notices & Update Health Plan Documents & Procedures Quickly;  Employer & Other Health Plans & Other HIPAA-Covered Entities & Their Business Associates Must Comply With New HHS Health Information Data Breach Rules By September 23; COBRA, HIPAA, GINA, Mental Health Parity or Other Group Health Plan Rule Violations Trigger New Excise Tax Self-Assessment & Reporting ObligationsThese and other developments make it imperative that health plans, their sponsors, administrators, insurers, fiduciaries and service providers get serious about complying with HIPAA.

Curran Tomko Tarski LLP Can Help

If your organization need advice or assistance in reviewing, updating, administering or defending its health plan, HIPAA or other privacy policies, practices, business associate or other agreements, notices or other related activities, consider contacting Curran Tomko Tarski LLP Partner Cynthia Marcotte Stamer.

A widely published author and speaker on HIPAA and other employee benefit and human resources related matters, Ms. Stamer has extensive experience advising health plans, their employer and other sponsors, health insurers, TPAs and other business associates and others about HIPAA and other health plan and privacy matters. Currently serving as both Chair of the American Bar Association (ABA) RPTE Employee Benefits & Other Compensation Group and as an ABA Joint Committee on Employee Benefits Council representative and Former Chair of the ABA Health Law Section Managed Care & Insurance Interest Group, Ms. Stamer has more than 23 years experience assisting employers, insurers, plan administrators and fiduciaries and others to design, implement, draft and administer health and other employee benefit plans and to defend audits, litigation or other disputes by private parties, the IRS, Department of Labor, Office of Civil Rights, Medicare, state insurance regulators and other federal and state regulators. A nationally recognized author and lecturer, Ms. Stamer also speaks and writes extensively on these and other related matters. For additional information about Ms. Stamer and her experience or to access other publications by Ms. Stamer see here or contact Ms. Stamer directly.   For additional information about the experience and services of Ms. Stamer and other members of the Curran Tomko Tarksi LLP team, see here.

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©2010 Cynthia Marcotte Stamer. All rights reserved.