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August 5, 2020

Updated Medicaid/CHIP Premium Assistance Notice

Individuals who are eligible for employer-sponsored group health coverage, but are unable to afford the premium, may be eligible to receive premium assistance from a state’s Medicaid agency or Children’s Health Insurance Program (CHIP). Thus, employers sponsoring health plans are obligated to annually provide a premium assistance notice to their workforce. This notification can be accomplished by using a model notice provided by the Department of Labor’s Employee Benefit Security Administration (EBSA).

EBSA recently revised its model Notice for Employers Regarding Premium Assistance Opportunities, and made current as of July 31, 2020. The revised notice differs from the model notice issued in January 31, 2020, as follows:

  • With regard to program changes, Colorado has added contact information about its Health Insurance Buy-in Program (HIBI); and Maine added contact information about its Private Health Insurance Premium program.
  • The website address and phone number for the Medicaid office in Wyoming has changed.

The revised Medicaid/CHIP premium assistance notice is available for viewing and/or downloading from the EBSA’s website, in both English (PDF or Word) and Spanish (PDF or Word).

Method of distributing notice. The Medicaid/CHIP premium assistance notice can be included in other plan materials, such as open enrollment materials, or a summary plan description. Alternatively, it can be provided as a separate document. If the notice is to be included with other plan material, it must be clearly delineated as a unique document. The notice can be provided in written form; or, electronically, as long the DOL’s electronic disclosure rules are followed.

Employers are welcome to modify the model notice; though, it is very important that the document provided to affected individuals clearly explains the right to premium assistance; and most importantly, provides at least minimal information about how to contact the relevant state Medicaid or CHIP office.

Who gets the notice?  The notice explaining the right to premium assistance must be provided to employees residing in the below-listed states at least once annually, without regard to where the employer is located, or where the health plan is sitused: 

States Offering Premium Assistance

Alabama

Massachusetts

Pennsylvania

Alaska

Minnesota

Rhode Island

Arkansas

Missouri

South Carolina

California

Montana

South Dakota

Colorado

Nebraska

Texas

Florida

Nevada

Utah

Georgia

New Hampshire

Vermont

Indiana

New Jersey

Virginia

Iowa

New York

Washington

Kansas

North Carolina

West Virginia

Kentucky

North Dakota

Wisconsin

Louisiana

Oklahoma

Wyoming

Maine

Oregon

 

 

Penalty for failure to provide notice.   Failure to notify employees of premium assistance opportunities could result in a penalty assessment of up to $119 per day, per employee (as indexed, beginning January 15, 2020).

The information contained in this article is provided as general guidance and may be affected by changes in law or regulation. This article is not intended to replace or substitute for accounting or other professional advice. Please consult a CBIZ professional. This information is provided as-is with no warranties of any kind. CBIZ shall not be liable for any damages whatsoever in connection with its use and assumes no obligation to inform the reader of any changes in laws or other factors that could affect the information contained herein.

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