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CHIPRA - Notice Requirements


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The Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 took effect on April 1, 2009. The law provides that the DOL and HHS will work with state Medicaid and CHIP agencies to produce model notices by April 1, 2010. And employers are required to provide employees with the initial notice beginning with the first plan year that begins after the date the initial notices are issued.

I am confused. I thought that employers needed to issue notices now to employees. Is that true? Or can employers wait until the model notices are issued? If they have to notify now, what is the deadline to issue the notice? And are they left to draft their own notices?

Thanks.

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Our understanding is that insurance and cafeteria plan contracts/documents have to be updated now to allow for the special 60 day open enrollment, but notices to employees can wait for the DOL/HHS model notices.

If someone shows up with a claim to be enrolled, it might be helpful to you and the employee to have your own summary notice listing the basics for reference.

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The model notices are to describe the new CHIP program itself and the notices will not need be delivered for quite awhile.

There is a separate requirement that plans must permit employees who lose coverage under CHIP or Medicaid or who become eligible for a state CHIP or Medicaid subsidy with a 60-day special enrollment right into the plan. That requirement was effective April 1. There is no statutory requirement to notify employees of this requirement but plans must permit the special enrollment now.

Although there is no current notice requirement (and SPDs do not have to be amended now), we are advising clients to send a brief notice to employees informing them of the new special enrollment right.

Note that SPDs probably will have to be changed in more than a few places because often they refer to the "30-day" special enrollment period.

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Does anyone know what the process is for opting out? Also, if we don't opt out, how do we know who qualifies for the subsidy and how much the subsidy is? We are in Virginia. I have read that Virginia is participating in the subsidy piece. However, I have been unable to find Virginia-specific information on the subsidy process (and opt-out process).

Thanks.

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