Employers that sponsor group health plans should provide certain benefit notices in connection with their plans’ open enrollment periods. Some of these notices must be provided at open enrollment time, such as the Summary of Benefits and Coverage (SBC).
Other notices, such as the Women’s Health and Cancer Rights Act (WHCRA) notice, must be distributed annually. Although these annual notices may be provided at different times throughout the year, employers often choose to include them in their open enrollment materials for administrative convenience. Some of these notices may be included in the plan’s Summary Plan Description (SPD) or detailed benefits summary provided by a health insurance issuer or third-party administrator (TPA).
In addition, employers should review their open enrollment materials to confirm that they accurately reflect the terms and cost of coverage. In general, any plan design changes for 2026 should be communicated to plan participants either through an updated SPD or a Summary of Material Modifications (SMM).
This Compliance Overview includes a chart that summarizes the benefit notices employers should provide at open enrollment time.
Summary of Benefit Notices
- SBC: Required for group health plans and issuers. Must be provided annually. Template available.
- Medicare Part D Notice: Required annually before Oct. 15 for plans with prescription coverage. Model notices available.
- WHCRA Notice: Required at enrollment and annually for plans covering mastectomies. Model language provided.
- CHIP Notice: Annual requirement for employers in states with CHIP premium subsidies. Model notice available.
- SPD: Required within 90 days of coverage and every 5–10 years. May be included in open enrollment materials.
- COBRA General Notice: Must be issued within 90 days of coverage. Often included in enrollment packets. Model notice available.
- Grandfathered Plan Notice: Required to preserve grandfathered status. Model notice provided.
- HIPAA Privacy Notice: Required for self-insured plans. Special rules apply to insured plans. Model notices available.
- HIPAA Special Enrollment Notice: Required at or before enrollment. Often included in SPD.
- Summary Annual Report (SAR): Required for plans filing Form 5500. Exempt if unfunded. Model SAR available.
- Wellness Notice – HIPAA: Required for health-contingent wellness programs. Sample language available.
- Wellness Notice – ADA: Required when collecting health info/medical exams. Sample notice provided.
- Individual Coverage HRA Notice: Required at least 90 days before plan year start. Model notice provided.
Links and Resources
This Compliance Overview is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice. ©2021–2025 Zywave, Inc. All rights reserved.