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Several health care reform-related model notices have been issued since the passage of the Patient Protection and Affordable Care Act (“PPACA”) and recently have been made available on the Department of Labor’s (DOL) website. Plan administrators, plan sponsors and insurers should review the notice requirements and take action to update enrollment materials, summary plan descriptions, benefit summaries and other plan documents accordingly. The model notices and their corresponding required effective dates include the following:

• Prohibition on Lifetime Limits Model Notice. Health plans and health insurance issuers must provide a notice to an individual whose coverage or benefits ended because he or she reached the lifetime limit on benefits under the plan and who otherwise is or will become eligible for benefits under the group health plan or group coverage, that the lifetime limit on the dollar value of benefits no longer applies. Additionally, if such individual is not enrolled in the plan or health insurance coverage, or if an enrolled individual is eligible for but not enrolled in any benefit package under the plan or coverage, then the plan or issuer also must provide the individual with an opportunity to enroll and a notice of that opportunity to enroll. These notices must be provided beginning not later than the first day of the first plan year on or after September 23, 2010. The notices may be included with other plan enrollment materials, as long as the statement is prominent. Access DOL’s Prohibition on Lifetime Limits Model Notice.

• Extension of Dependent Coverage to Age 26 and Opportunity to Enroll Model Notice. Plans providing coverage for a participant’s child must provide an enrollment opportunity, and a written notice regarding the enrollment opportunity, to a child whose plan coverage terminated. This enrollment opportunity and notice also must be given to a participant’s child who was not eligible for coverage or was denied coverage because the availability of dependent coverage ended before the child attained age 26. The enrollment opportunity and the notice must be provided not later than the first day of the first plan year beginning on or after September 23, 2010. The notice may be included with other plan enrollment materials, as long as the statement is prominent. Access DOL’s Dependent Coverage and Opportunity to Enroll Model Notice.

• Patient Protection Model Notice. Health plans and health insurance issuers that require participants and their beneficiaries to designate a primary care provider must provide each participant with a notice informing the participant of the terms of the plan or coverage regarding the designation of a primary care provider, that they may choose any participating primary care provider who is available to accept the participant or beneficiary as a patient, and, for a child, that a pediatrician may be selected as a primary care provider. Additionally, plans and issuers that provide coverage for obstetrical and gynecological care must provide their participants with a notice of their rights to obtain access to such care without prior authorization or a referral. These notices must be provided whenever a summary plan description or a similar description of benefits is provided. The regulations prescribing these notices are generally effective on first day of the first plan year beginning on or after September 23, 2010. Access DOL’s Patient Protection Model Notice.

• Grandfathered Health Plan Model Language. Health plans or health insurance issuers that desire to retain “grandfathered” status, must, among other requirements, provide notice to participants and beneficiaries that the plan or coverage is believed to be a “grandfathered health plan.” Beginning not later than the first day of the first plan year on or after September 23, 2010, the notice must be included in any plan materials provided to participants and beneficiaries which describe the benefits provided under the plan or coverage. Access DOL’s Grandfathered Health Plan Model Language.

If you have any questions regarding these model notices, please contact Deborah Bracy (216.861.7354 or ), Susan Whittaker Hughes (216.861.7841 or ) or any member of the Baker Hostetler Health Care Reform Team.

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