DOL Releases Model Employer CHIP Notice

Background

Most states currently provide premium assistance under Medicaid or CHIP programs for health coverage of qualifying residents and their dependents. At present, only 10 states do not offer premium assistance – Connecticut, Delaware, Hawaii, Illinois, Maryland, Michigan, Mississippi, Ohio, South Dakota, and Tennessee.

The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) requires employers that offer group health plans to notify their employees of potential opportunities to receive premium assistance under current state programs. CHIPRA also added new HIPAA special enrollment rights that allow employees and their dependents to enroll in their employers’ group health plans if they lose eligibility for Medicaid or CHIP coverage or become eligible for premium assistance under Medicaid or CHIP. The DOL has now released a Model Employer CHIP Notice that employers may use to satisfy their new notice obligations under CHIPRA.

Model Notice

Employers Required to Provide Notice. An employer must provide the Employer CHIP notice if it maintains a group health plan (i.e., if the employer provides medical care benefits directly or through insurance, reimbursement, or otherwise) in a state that provides premium assistance under Medicaid or under a state children’s health insurance program for the purchase of group health plan coverage. Thus, whether an employer is subject to the notice requirement depends on where the group health plan participants or beneficiaries reside – not the location or principal place of business of the employer, plan, plan administrator, insurer or affiliated service provider.

Employees Entitled to Notice. Regardless of plan enrollment status, each employee who resides in a state that offers premium assistance programs must receive notice of potential opportunities for assistance. If the state in which the employee (or employee’s family) resides does not offer premium assistance programs, no notice is required.