ERISA-EBSA Announces That It Has Published A Model Notice To Use Regarding Eligibility For Medical Assistance Under Medicaid Or The Children’s Health Insurance Program

The Employee Benefits Security Administration (the “EBSA”) has announced the publication of a model notice which can be used to meet the notice requirements of the Children’s Health Insurance Program Reauthorization Act of 2009 (“CHIPRA”).

An employer could be maintaining a group health plan in a State which provides medical assistance, either under a State Medicaid plan under the Social Security Act (the “SSA”), or under a child health insurance program (a “CHIP”) under the SSA. This assistance takes the form of money to pay for coverage of employees and their dependents under a group health plan. Under ERISA, as amended by CHIPRA, an employer, which maintains a group health plan in such a State-like New York, New Jersey and Pennsylvania- is required to provide to its employees, each year, a notice which describes the opportunity available in the employee’s State of residence to receive this medical assistance. This notice is referred to as the “Employer CHIP Notice”. ERISA requires the EBSA to provide employers with a model Employer CHIP Notice by February 4, 2010. In turn, the employer must provide the initial annual Employer Chip Notices to employees by the later of (1) the first day of the first plan year of its group health plan that begins after the date on which the model notice is published (February 4, 2010) or (2) May 1, 2010.

Thus, for a calendar year group health plan, the first Employer CHIP Notices must be provided by January 1, 2011. For convenience, an employer may generally combine the Employer CHIP Notice with other plan materials, such as enrollment packets, open season materials, or the plan SPD, provided that (1)these materials are furnished by the date on which the Employer Chip Notice is due, (2) these materials are furnished to all employees entitled to receive the Employer CHIP Notice, and (3) the Employer CHIP Notice appears separately and in a manner which ensures that an employee could reasonably be expected to appreciate its significance.

The model Employer CHIP Notice was designed as a “template” that an employer may send to the residents of any State. States may wish to include additional information on their Web sites and in their own compliance assistance materials. The approach of the model Employer CHIP Notice is to provide a very brief description of the available medical assistance and rely on State contact information for State-specific program descriptions. An employer which nevertheless wants to provide more comprehensive State-specific information to its employees may modify the model Employer CHIP Notice to add this information, as long as the minimum relevant State contact information is retained.

The model Employer CHIP Notice is available here.

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