Curi­ous about when you should noti­fy a par­tic­i­pant about a change to their health care plan?

The answer is that it depends!

Noti­fi­ca­tion must hap­pen with­in one of three time frames: 60 days pri­or to the change, no lat­er than 60 days after the change, or with­in 210 days after the end of the plan year.

For mod­i­fi­ca­tions to the sum­ma­ry plan descrip­tion (SPD) that con­sti­tute a mate­r­i­al reduc­tion in cov­ered ser­vices or ben­e­fits, notice is required with­in 60 days pri­or to or after the adop­tion of the mate­r­i­al reduc­tion in group health plan ser­vices or ben­e­fits. (For exam­ple, a decrease in employ­er con­tri­bu­tion is a mate­r­i­al reduc­tion in cov­ered ser­vices or ben­e­fits. So is a mate­r­i­al mod­i­fi­ca­tion in any plan terms affect­ing the con­tent of the most recent sum­ma­ry of ben­e­fits and cov­er­age (SBC).) While the rule here is flex­i­ble, the def­i­nite best prac­tice is to give advance notice. For col­lec­tive prac­ti­cal pur­pos­es, employ­ees should be told pri­or to the first increased withholding.

How­ev­er, if the change is part of open enroll­ment, and com­mu­ni­cat­ed dur­ing open enroll­ment, this is con­sid­ered accept­able notice regard­less of whether the SBC, SPD, or both are chang­ing. Essen­tial­ly, open enroll­ment is a safe har­bor for all 60-day pri­or/60-day post notice requirements.

Final­ly, changes that do not affect the SBC and are not a mate­r­i­al reduc­tion in ben­e­fits must be com­mu­ni­cat­ed and sum­ma­rized with­in 210 days after the end of the plan year.

By Danielle Capilla

Orig­i­nal­ly pub­lished by