Your Complete HR Posting Solutions: State and Federal Requirements PASBO 55th Annual Conference March 11, 2010
What We Are Covering Today General HR Posting • State of PA • Federal • Group Health Plans • State • Federal
State of PennsylvaniaRequired Posting • Equal Employment Opportunity Poster • Equal Pay Poster • Minimum Wage and Overtime Hours Poster • Child Labor Law Poster • Schedule of Hours for Minors (To be Completed by Employer) • Employment Provisions of the Pennsylvania Humans Relations Act • Education Provisions of the PA Human Relations Act and the PA Fair Educational Opportunities Act • Right to Know Poster • Workers Compensation Insurance Poster • Unemployment Compensation Benefits Poster • Public Accommodations Provisions
Whistleblower Protection Provisions • Most labor and public safety laws and many environmental laws mandate whistleblower protections for employees who complain about violations of the law by their employers. • Remedies can include job reinstatement and payment of back wages. • OSHA enforces the whistleblower protections in most laws.
Uniformed Services Employment and Reemployment Act (USSERRA) • The Uniformed Services Employment and Reemployment Rights Act (USERRA) protects service members' reemployment rights when returning from a period of service in the uniformed services, including those called up from the reserves or National Guard, and prohibits employer discrimination based on military service or obligation. • The Veterans’ Employment and Training Service (VETS)enforces USERRA. • You must provide to persons covered by USERRA a notice of the rights, benefits, and obligations of the employees and employers under USERRA. • You can post the notice entitled Your Rights Under USERRA where employer notices are customarily placed, mail it, or by distributing it via electronic mail. There is no size requirement for the poster version of the notice. http://www.dol.gov/vets/programs/userra/USERRA_Federal.pdf)”
Fair Labor Standards Act (FLSA) • Primary wage-hour law at the federal level. Imposes minimum wage and overtime pay and also includes child labor provisions aimed at protecting minors. • FLSA requires employers to pay workers no less than the federal minimum wage. • Under FLSA overtime requirements, employers must pay covered employees one and one-half times their regular hourly ratefor time worked in excess of 40 hours per week. • Overtime pay is not mandated for certain categories of “exempt” employees, such as executive, professional, and administrative employees. • The child labor provisions protect minors by limiting the types of work they can perform. Generally speaking, individuals under age 18 cannot be employed in hazardous occupations, those under age 16 cannot be employed in manufacturing or mining jobs, and those under age 14 cannot work in any nonagricultural occupation covered by the FLSA. • Many states have their own minimum wage, overtime, and child labor laws. State mandates prevail if they are more stringent than the federal standards or more beneficial to employees.
Age Discrimination in Employment Act (ADEA) Employers with 20 or more employees are prohibited from discriminating against individuals 40 years of age or older on the basis of age. The ADEA prohibits age-based discrimination in connection with hiring, advancement, termination, compensation, benefits, and other terms and conditions of employment. Employers cannot limit, segregate, or classify applicants or employees aged 40 or older in ways that adversely affect their job opportunities. In most cases, the ADEA also prohibits forced retirement based solely on age. If employers seek waivers from older workers in layoff situations—asking them to give up their rights to pursue employment-related claims in exchange for enhanced severance benefits or early retirement packages—employers must meet specific requirements to ensure that such waivers are knowingly and voluntarily signed by employees. The ADEA is enforced by the Equal Employment Opportunity Commission. Many states have their own laws against age discrimination in the workplace, some of which are broader than the ADEA.
Equal Pay Act (EPA) • Bars employers from gender-based pay discrimination. • Employers cannot retaliate against employees for opposing pay discrimination, pursuing EPA charges, or participating in EPA proceedings. • Employers are prohibited from paying employees differently based on gender for performing equal work in the same establishment under the same conditions. • Employers must maintain more than the regular wage and hour records required by the federal Fair Labor Standards Act. Additional records include job descriptions, job evaluations, and descriptions of compensation systems or practices that can explain pay differentials between employees of opposite genders. • The Equal Employment Opportunity Commission administers and enforces EPA. Employers also can be sued by employees for alleged EPA violations.
FMLA • Administered by the Wage and Hour Division, the Family and Medical Leave Act (FMLA) requires employers of 50 or more employees to provide up to 12 weeks of unpaid, job-protected leave to eligible employees for the birth or adoption of a child or for the serious illness of the employee or a spouse, child or parent. • Final rules effective on January 16, 2009 - updated to implement new military family leave entitlements enacted under the National Defense Authorization Act for FY 2008. • Requires that the employee's group health insurance coverage be maintained under the same terms and conditions during the leave as if the employee had not taken leave. • The Employment Standards Administration, Wage and Hour Division administers and enforces FMLA for all private, state and local government employees, and some federal employees.
FMLA • General Notice Requirements • Provide to each employee by including in employee handbooks or other written guidance about benefits or leave rights. • If you don’t have a handbook or other written guidance, you may distribute a copy of the general notice to each newly hired employee. • You can distribute the notice electronically. • Eligibility Notice Requirements • When an employee requests FMLA leave or you know that an employee’s leave may be for an FMLA-qualifying reason. • You must notify the employee that they are eligible for FMLA leave within five business days, absent extenuating circumstances. • The notice must state if the employee is eligible for FMLA leave. • If the employee is noteligible, must state at least one reason why.
Qualified Medical Child Support Orders • Group health plans offering family coverage must comply with qualified medical child support orders and National Medical Support Notices. • QMCSOs are issued by state courts or administrative agencies usually pursuant to state domestic relations laws that require employees to provide heath care benefits for their children. • National Medical Support Notices are issued by state agencies pursuant to the Child Support Performance and Incentive Act of 1998 that require noncustodial parents to provide health care benefits for their children. • Upon receipt of a QMCSOs or National Medical Support Notices: • Must enroll employees' children in the health care plans and, • Make any required premium deductions from employees' paychecks.
Recent Health Plan Legislation • Final rules on Cafeteria Plan – effective 1/1/2010 • Mental Health Parity and Addiction Equity Act of 2008 – effective for plan years beginning on or after 10/3/2009 or 1/1/2010 for calendar year plans • Michelle’s Law – effective for plan years beginning on or after 11/8/2009 • Genetic Information Nondiscrimination Act – effective for plan years beginning on or after 5/21/2009 • Health Flexible Spending Account Distributions for Reservists (HEART Act) – effective 9/2008 • Medicare Mandatory Reporting – effective 1/1/2009 • Final FMLA regulations – effective 1/16/2009 • Americans with Disability Act Amendments Act – effective 1/1/2009 • Newborns’ and Mothers’ Health Protection Act (amendment to) – effective 1/1/2009 • COBRA Subsidy – American Recovery and Reinvestment Act – effective 2/17/2009 • Children’s Health Insurance Program Reauthorization Act of 2009 – effective 4/1/2009 • American Recovery and Reinvestment Act – Health Insurance Portability and Accountability Act (HITECH Act) – effective 2/17/2009 • Pennsylvania Dependent Student eligibility extension
ERISA ExemptionWord of Caution… • Generally, public school districts are governed by state law, not ERISA, as are other governmental entities. • More specifically, governmental plans are exempt from ERISA's participation, minimum coverage, vesting and funding standards. • Some Plan Documents clearly state that the plan will comply with ERISA unless state law overrides ERISA. If the plan does not intend to comply with ERISA's rules, the language should not be included. • Make sure your Documents do not commit you to comply with ERISA rules by providing ERISA language rights to employees. • If the plan failed to comply with ERISA rules, there would be no remedy under ERISA, but there would be a contract breach and associated relief under applicable state law. • Participants in school district plans are governmental employees. The Employee Benefits Security Administration (EBSA) has stated that, whether or not a plan is “established and maintained” by a governmental entity depends upon the extent to which a governmental entity funds and administers the plan.
If your Plan is “self-funded” you are not subject to State Mandated Benefits. You are not required to provide health insurance to employees. If you do, you must cover the range of benefits and services mandated by state law. State of Pennsylvania Mandates for Group Health Plans
PA MandatesCommunications • Gag Clauses - Health care plans are prohibited from penalizing or restricting health care providers from discussing: • the process to deny payment for a health care service; • medically necessary and appropriate care with or on behalf of a beneficiary; or • the decision of any plan to deny payment for a health care service. • Grievance Processes - Health benefit plans must establish both internal and external grievance processes. • Internal - an initial review that includes • a review by one or more persons who did not previously deny payment for the health care service; • the completion of the review within 30 days or receipt of the grievance; and • a written notification to the enrollee and health care provider about the decision within five business days • The second level review must include: • review of the first level decision by three or more persons who did not participate in any previous decision to • deny payment for the health care services; • a written notification to the right to appear before the second level review committee; • a review within 45 days or receipt of the request for review; • written notification to the beneficiary and health care provider about the decision within five days of the • decision. • the notice must include the basis and clinical rationale for the decision and the procedure for appealing the • decision. • External grievance process - an external grievance process must be conducted by an independent utilization review firm not directly related to the health benefit plan.
PA Mandates Eligibility • Adopted Children - must be covered under the same terms and conditions as other family members. • Dependent Children - Full-time students whose studies are interrupted by service in the reserves or Pennsylvania National Guard must be extended health care benefits as a dependent of their parent until they finish school, regardless of their age. • Optional Extended Coverage Through Age 29: provided the child: • is not married; • has no dependents; • is a resident of Pennsylvania or is enrolled as a full-time student at an institution of higher education; • and • is not provided coverage under any other group or individual health insurance policy, or enrolled in or • entitled to benefits under any government program. • Newborns - must cover newborns from the moment of birth for injury or sickness including treatment of medically diagnosed: • congenital defects; • birth abnormalities; • prematurity; and • routine nursery care. • Pre-Existing Conditions - must cover any loss occurring after 12 months from any pre-existing condition not specifically excluded from coverage by terms of the plan. The plan can not include wording that would permit a defense based upon pre-existing conditions, except as provided.
PA MandatesRequired Coverage of Services & Supplies Autism Spectrum Disorder - Effective July 1, 2009, plans must provide to covered individuals under 21 years of age coverage for the diagnostic assessment and treatment of autism spectrum disorders. The mandate applies to policies and contracts for groups of more than 50. Plans must provide a maximum benefit of $36,000 per year but must not subject any limits on the number of visits to an autism service provider for treatment of autism spectrum disorders. After Dec. 31, 2011, the Insurance Commissioner will publish in the Pennsylvania Bulletin an adjustment to the maximum benefit equal to the change in the U.S. Department of Labor Consumer Price Index for All Urban Consumers (CPI-U) in the preceding year, and the published adjusted maximum benefit will be applicable to the following calendar years to health insurance policies issued or renewed in those calendar years. Childhood Immunizations - plans must provide coverage for childhood immunizations. Plans also must provide coverage for booster doses of all immunizing agents used in childhood immunizations. Colorectal Cancer Screening - plans must provide coverage for colorectal cancer screening for covered individuals in accordance with American Cancer Society guidelines for colorectal cancer screening published as of Jan. 1, 2008, and consistent with approved medical standards and practices. Diabetes-Related Services/Supplies - plans or policies, must cover diabetic-related equipment, supplies and, outpatient self-management training and education, including medical nutrition therapy.
PA MandatesRequired Coverage of Services & Supplies Emergency Services - plans must reimburse beneficiaries or providers for medically necessary services that are provided in a hospital emergency facility due to a medical emergency. Gynecological Services - Annual gynecological examinations, including pelvic and clinical breast examinations, and routine pap smears must be covered. Low-Protein Food Products for Inherited Amino Acid/Organic Acid Diseases - Health benefit plans must provide coverage for the cost of nutritional supplements or formulas as medically necessary for the therapeutic treatment of phenylketonuria, branched-chain ketonuria, galactosemia, and homocystinuria. Mammography - plans that provide hospital or medical/surgical coverage must all provide coverage for mammograms. The minimum coverage required must include all costs associated with a mammogram every year for women 40 years of age or older and with any mammogram based on a physician's recommendation for women under 40 years of age. Maternity Health Care - 48/96-hour maternity stay: must cover at least 48 hours of inpatient care after a normal vaginal delivery; and 96 hours of inpatient care following a cesarean delivery. Shorter stays are only allowed if the treating physician feels that it is appropriate for the mother and newborn. Maternity policies must cover at least one home health care visit by a licensed health care provider whose scope of practice includes postpartum care within 48 hours of leaving the hospital for early discharges. These home visits are not subject to copayment, coinsurance, or deductibles.
PA MandatesRequired Coverage of Services & Supplies • Outpatient Cancer Treatment - plans must provide for reimbursements of cancer chemotherapy and hormone benefits rendered at the outpatient department of a hospital or other medically appropriate treatment setting. • Standing Referrals - Beneficiaries with a life-threatening, degenerative, or disabling condition that meets their managed care plan's established standards can request and receive either a standing referral to an appropriate specialist or designation of a specialist who will provide and coordinate their primary and specialty care. • Treatments for Specific Health Conditions – Pre MHP • Alcoholism and Drug Treatment/Rehabilitation - Group policies must cover at least: • • seven days of detoxification treatment per admission (a lifetime limit of four admissions for • detoxification is permitted); • • 30 days per year of residential care (a lifetime limit of 90 days is permitted); and • • 30 outpatient visits per year (a lifetime limit of 120 visits is permitted). • Two outpatient visits can be exchanged for one residential treatment day to increase the available residential treatment period.
PA MandatesRequired Coverage of Services & Supplies • Breast Cancer Treatment - plans that provide benefits for mastectomy must also include coverage for: • prosthetic devices; • physical complications including lymphedemas; and • reconstructive surgery. • mastectomy benefits must include inpatient care following surgery, as determined by a female beneficiary's treating physician. • coverage for a home care visit within 48 hours of surgery, if the treating physician feels it is medically necessary. • coverage for prosthetic devices inserted during reconstructive surgery and reconstructive surgery itself may be limited to those procedures performed within six years of the date of the mastectomy. • Beneficiaries must receive written notice that mastectomy benefits are available when they enroll in the plan, and annually thereafter. Coverage of related prosthetic devices and reconstructive surgery is subject to the same deductible and coinsurance conditions applied to other benefits.
PA MandatesRequired Coverage of Services & Supplies • Mental Health Treatment • Serious mental illnesses: Annual coverage for serious mental illness must include at least 30 inpatient days and 60 outpatient days. Beneficiaries can convert inpatient day benefits to outpatient day coverage on a one-for-two basis. Maximum annual and lifetime coverage limits for severe mental illness must be the same as for other conditions. Cost-sharing arrangements, including but not limited to deductibles and copayments, cannot prohibit access to care. • Serious mental illnesses include: • • schizophrenia; • • bipolar disorder; • • obsessive-compulsive disorder; • • major depressive disorder; • • panic disorder; • • bulimia nervosa; • • schizoaffective disorder; and • • delusional disorder.
PA MandatesAccess to Providers/Specialist • Providers - Plans must allow the following providers if the provider is licensed, the service is within the provider's scope of services, and the service is covered by the health benefit plan: • Chiropractors, Dentists, Doctors of Medicine, Osteopaths, Physical Therapists, Podiatrists, Psychologists • Nurses - plans must provide reimbursements for the services provided by the following types of nurses: • certified registered nurse anesthetists; • certified registered nurse practitioners; • certified enterostomal therapy nurses; • certified community health nurses, • certified psychiatric mental health nurses; • certified clinical nurse specialists; and • certified nurse midwives. • Obstetricians/Gynecologists - plans must provide direct access to obstetrical and gynecological services without a primary care physician's prior approval. • Optometrists - plans must provide reimbursements for services rendered by optometrists. However, mandatory coverage for reimbursements does not extend to ophthalmic materials, lenses, spectacles, eyeglasses, and/or other appurtenances.
PA MandatesMiscellaneous • Domestic Violence - plans are prohibited from discriminating against victims of domestic violence by: • • denying or restricting their coverage; • • adding a surcharge; • • canceling a policy; or • • refusing to issue or renew a policy. • Social Security Number – no health insurer can place a member’s social security number on a health insurance ID card.
Federal Laws & Heath Plans
A Little ERISA History Title I of ERISA is administered by the Employee Benefits Security Administration (EBSA) (formerly the Pension and Welfare Benefits Administration) and imposes a wide range of fiduciary, disclosure and reporting requirements on fiduciaries of pension and welfare benefit plans and on others having dealings with these plans. These provisions preempt many similar state laws. Under Title IV, certain employers and plan administrators must fund an insurance system to protect certain kinds of retirement benefits, with premiums paid to the federal government's Pension Benefit Guaranty Corporation (PBGC). EBSA also administers reporting requirements for continuation of health-care provisions, required under the Comprehensive Omnibus Budget Reconciliation Act of 1985 (COBRA) and the health care portability requirements on group plans under the Health Insurance Portability and Accountability Act (HIPAA). You are getting VERY Sleepy…..
More ERISA History • ERISA is divided among the U.S. Department of Labor, the Internal Revenue Service of the Department of the Treasury (IRS), and the Pension Benefit Guaranty Corporation (PBGC). • Title I, which contains rules for reporting and disclosure, vesting, participation, funding, fiduciary conduct, and civil enforcement, is administered by the U.S. Department of Labor. • Title II of ERISA, which amended the Internal Revenue Code to parallel many of the Title I rules, is administered by the IRS. • Title III is concerned with jurisdictional matters and with coordination of enforcement and regulatory activities by the U.S. Department of Labor and the IRS. • Title IV covers the insurance of defined benefit pension plans and is administered by the PBGC. • Prior to a 1978 reorganization, there was overlapping responsibility for administration of the parallel provisions of Title I of ERISA and the tax code by the U.S. Department of Labor and the IRS, respectively. • As a result of this reorganization, the U.S. Department of Labor has primary responsibility for reporting, disclosure and fiduciary requirements; and the IRS has primary responsibility for participation, vesting and funding issues. • The U.S. Department of Labor may intervene in any matters that materially affect the rights of participants, regardless of primary responsibility.
What Does Apply for You? HIPAA health insurance reform requirements of Part A of title XXVII of the Public Health Service (PHS) Act apply to group health plans. The Newborns' and Mothers' Health Protection Act of 1996, The Mental Health Parity Act of 1996 (MHPA), The Women's Health and Cancer Rights Act of 1998 (WHCRA), The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), The Genetic Information Nondiscrimination Act of 2008 (GINA), Michelle's Law (2008) and; The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA). There are ALWAYS exceptions to the rules
What Plans are Exempt from ERISA? Under ERISA § 4(b) and other sections, the following plans are generally exempt: • plans sponsored by federal, state or local governments • plans sponsored by churches • workers’ compensation, unemployment compensation or disability insurance laws • plans maintained outside the U.S. primarily for nonresident aliens • unfunded executive compensation plans that provide additional benefits to executives and other high-paid employees IRC requirements continue to apply and must be observed in order to preserve tax-exempt treatment, where available, for plan participants.
Subject to Section 125? Two entirely separate pieces of legislation, but closely related. Schools, government and churches are “special” and do not have to follow ERISA rules. But, you are required to follow certain sections of the Internal Revenue Code, including Section 125. ERISA does not apply (including Title 1 – Reporting and Disclosure) to health and welfare benefits that schools offer, but if you offer pre-tax premiums towards coverage costs and/or flexible spending accounts – you are subject to Section 125. Which means you should have a plan document, along with all the other requirements of the Section 125 from our friends at the IRS. If you don’t comply with Section 125 rules, you could lose your tax status. Confused yet?
Subject to Section 125? • Cafeteria plans, if established, maintained, and administered in accordance with section 125 of the Internal Revenue Code offer tax-favored treatment. • If cafeteria plans do not comply with section 125, you lose tax-favored treatment and will be subject to penalties. • According to the Internal Revenue Code (Code) and the related Internal Revenue Service (IRS) guidelines, • all cafeteria plans must meet certain requirements found in Code Section 125, which includes a requirement that the plan be in writing (a formal plan document). • If the Code requirements aren't met, the district will not have a tax-qualified benefit plan, and employees will be taxed on their deferred salary used to pay health care premiums. • A premium-only plan (POP), also known as a premium conversion plan, is a form of a cafeteria plan under Code Section 125.
PA School Specific ProvisionsAct 43/110 How do you handle retired spouses when the retiree reaches age 65?
Special Rules for Nonfederal Government Employers Self Funded Plans
Self Funded PlansHIPAA Newborn’s and Mothers’ Health Protection Act Mental Health Parity Act of 1996 Women’s Health and Cancer Rights Act of 1998 Genetic Information Nondiscrimination Act of 2008 (GINA) The Mental Health Parity and Addiction Act of 2008 Michelle’s Law Children’s Health Insurance Program Reauthorization Act of 2009 Title XXVII was added to the PHS Act by Title I of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and has been amended by the following:
Self Funded Plans With the Exception of GINA and certification and disclosure of credible coverage – you can elect to not comply with: Newborn’s and Mothers’ Health Protection Act Mental Health Parity Act of 1996 Women’s Health and Cancer Rights Act of 1998 The Mental Health Parity and Addiction Act of 2008 Michelle’s Law Children’s Health Insurance Program Reauthorization Act of 2009 Non-Federal Government employers that have a self-funded plan can “Opt-Out” of Compliance Requirements of Title XXXVII of the Public Health Service (PHS)Act
Self Funded Plans Opt-Out Required Notice • School District A Group Health Plan is not provided through insurance. School District A elects under authority of section 2721(b)(2) of the Public Health Service (PHS) Act, and 45 CFR 146.180 of Federal regulations, to exempt School District A Group Health Plan from the following requirements of title XXVII of the PHS Act: • 1. Limitations on preexisting condition exclusion periods. • 2. Special enrollment periods. • 3. Prohibitions against discriminating against individual participants and beneficiaries • based on health status. • 4. Standards relating to benefits for mothers and newborns. • 5. Parity in the application of certain limits to mental health benefits. • 6. Required coverage for reconstructive surgery following mastectomies. • 7. Coverage of dependent students on medically necessary leave of absence. • This election has been made in conformity with all rules of the plan sponsor, including any public hearing, if required. I certify that the undersigned is authorized to submit this election on behalf of (name of plan). A copy of the notice to plan enrollees is enclosed. If CMS has any questions regarding this election, please contact (name) at (phone number).
Self Funded Plans Opt OutRequired Notice to Enrollees Under a Federal law known as the Health Insurance Portability and Accountability Act of 19(HIPAA), Public Law 104-191, as amended, group health plans must generally comply with the requirements listed below. However, the law also permits State and local governmental employers that sponsor health plans to elect to exempt a plan from these requirements for any part of the plan that is "self-funded" by the employer, rather than provided through a health insurance policy. School A has elected to exempt (name of plan) from (all) (or specify which ones) of the following requirements: Limitations on preexisting condition exclusion periods. A preexisting condition exclusion period generally may not exceed 12 months, and generally must be reduced by prior health coverage an individual has had. Also, a plan may not impose any preexisting condition exclusion relating to pregnancy as a preexisting condition, nor, under certain conditions, with respect to newborns or children adopted or placed for adoption. Special enrollment periods. Group health plans are required to provide special enrollment periods for individuals who do not enroll in the plan because they have other coverage, but subsequently lose that coverage. Also, if a plan provides dependent coverage, the plan must provide a special enrollment period for new dependents (and the employee if not already enrolled) within 30 days after a marriage, birth, adoption or placement for adoption. A 60-day special enrollment period applies to eligible individuals who lose eligibility for Medicaid coverage or coverage under a State child health plan, or become eligible under Medicaid or a State child health plan for group health plan premium assistance.
Self Funded Plans Opt OutRequired Notice to Enrollees, Continued Prohibitions against discriminating against individual participants and beneficiaries based on health status. A group health plan may not discriminate in enrollment rules or in the amount of premiums or contributions it requires an individual to pay based on certain health status-related factors: health status, medical condition (physical and mental illnesses), claims experience, receipt of health care, medical history, genetic information, evidence of insurability and disability. Standards relating to benefits for mothers and newborns. Group health plans offering health coverage for hospital stays in connection with the birth of a child generally may not restrict benefits for the stay to less than 48 hours for a vaginal delivery, and 96 hours for a cesarean section. Parity in the application of certain limits to mental health benefits. Group health plans (of employers that employ more than 50 employees) that provide both medical and surgical benefits and mental health or substance use disorder benefits must ensure that financial requirements and treatment limitations applicable to mental health or substance use d benefits are no more restrictive than the predominant financial requirements and treatment limitations applicable to substantially all medical and surgical benefits covered by the plan.
Self Funded Plans Opt OutRequired Notice to Enrollees, Continued Required coverage for reconstructive surgery following mastectomies. Group health plans that provide medical and surgical benefits for a mastectomy must provide certain benefits in connection with breast reconstruction as well as certain other related benefits. Coverage of dependent students on medically necessary leave of absence. Group health plans are required to continue coverage for up to one year for a dependent child, covered as a dependent under the plan based on student status, who takes a medically necessary leave of absence from a postsecondary educational institution. The exemption from these Federal requirements will be in effect for the (plan year) (period of plan coverage) beginning (specify date) and ending (specify date). The election may be renewed for subsequent plan years. HIPAA also requires the Plan to provide covered employees and dependents with a "certificate of creditable coverage" when they cease to be covered under the Plan. There is no exemption from this requirement. The certificate provides evidence that you were covered under this Plan, because if you can establish your prior coverage, you may be entitled to certain rights to reduce or eliminate a preexisting condition exclusion if you join another employer’s health plan, or if you wish to purchase an individual health insurance policy.
Health Plan Reporting & Notice Requirements
Calendar for Health Plan Reporting DOL/IRS Combined Requirements
Calendar for Health Plan ReportingDOL/IRS Combined Requirements