Improvement of certain notifications provided to qualified beneficiaries by group health plans in the case of COBRA qualifying events

(a)

Employee Retirement Income Security Act of 1974

(1)

In general

Section 606 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1166) is amended—(A)in subsection (a)(4), in the matter following subparagraph (B), by striking under this subsection and inserting under this part in accordance with the notification requirements under subsection (c); and(B)in subsection (c)—(i)by striking For purposes of subsection (a)(4), any notification and inserting

For purposes of subsection (a)(4)—(1)any notification

;

(ii)by striking , whichever is applicable, and any such notification and inserting

of subsection (a), whichever is applicable;(2)any such notification

; and

(iii)by striking such notification is made and inserting

such notification is made; and(3)any such notification shall, with respect to each qualified beneficiary with respect to whom such notification is made, include information regarding any Exchange established under title I of the Patient Protection and Affordable Care Act through which such a qualified beneficiary may be eligible to enroll in a qualified health plan (as defined in section 1301 of the Patient Protection and Affordable Care Act), including—(A)the publicly accessible Internet website address for such Exchange;(B)the publicly accessible Internet website address for the Find Local Help directory maintained by the Department of Health and Human Services on the healthcare.gov Internet website (or a successor website);(C)a clear explanation that—(i)an individual who is eligible for continuation coverage may be eligible to enroll instead, with financial assistance, in a qualified health plan offered through such Exchange, but, in the case that such individual elects to enroll in such continuation coverage and subsequently elects to terminate such continuation coverage before the period of such continuation coverage expires, such individual may not be eligible to enroll in a qualified health plan offered through such Exchange during a special enrollment period if more than 60 days have elapsed since the individual’s loss of coverage as an employee; (ii)an individual who elects to enroll in continuation coverage will remain eligible to enroll in a qualified health plan offered through such Exchange during an open enrollment period or another special enrollment period for which the individual is eligible and may be eligible for financial assistance with respect to enrolling in such a qualified health plan; and(iii)an individual may apply for, and if eligible, enroll in Medicaid or the Children’s Health Insurance Program (CHIP), at any time, with no special enrollment period required;(D)information on consumer protections with respect to enrolling in a qualified health plan offered through such Exchange, including the requirement for such a qualified health plan to provide coverage for essential health benefits (as defined in section 1302(b) of the Patient Protection and Affordable Care Act) and the requirements applicable to such a qualified health plan under part A of title XXVII of the Public Health Service Act; and(E)information on the availability of financial assistance with respect to enrolling in a qualified health plan.

(2)

Effective date

The amendments made by paragraph (1) shall apply with respect to qualifying events occurring on or after the date that is 90 days after the date of the enactment of this Act.(b)

Public Health Service Act

(1)

In general

Section 2206 of the Public Health Service Act (42 U.S.C. 300bb–6) is amended—(A)by striking In accordance and inserting the following:

(a)

In general

In accordance

;

(B)by striking of such beneficiary’s rights under this subsection and inserting of such beneficiary’s rights under this title in accordance with the notification requirements under subsection (b); and(C)by striking For purposes of paragraph (4), and all that follows through such notification is made. and inserting the following:

(b)

Rules relating to notification of qualified beneficiaries by plan administrator

For purposes of subsection (a)(4)—(1)any notification shall be made within 14 days of the date on which the plan administrator is notified under paragraph (2) or (3) of subsection (a), whichever is applicable;(2)any such notification to an individual who is a qualified beneficiary as the spouse of the covered employee shall be treated as notification to all other qualified beneficiaries residing with such spouse at the time such notification is made; and(3)any such notification shall, with respect to each qualified beneficiary with respect to whom such notification is made, include information regarding any Exchange established under title I of the Patient Protection and Affordable Care Act through which such a qualified beneficiary may be eligible to enroll in a qualified health plan (as defined in section 1301 of the Patient Protection and Affordable Care Act), including—(A)the publicly accessible Internet website address for such Exchange;(B)the publicly accessible Internet website address for the Find Local Help directory maintained by the Department of Health and Human Services on the healthcare.gov Internet website (or a successor website);(C)a clear explanation that—(i)an individual who is eligible for continuation coverage may be eligible to enroll instead, with financial assistance, in a qualified health plan offered through such Exchange, but, in the case that such individual elects to enroll in such continuation coverage and subsequently elects to terminate such continuation coverage before the period of such continuation coverage expires, such individual may not be eligible to enroll in a qualified health plan offered through such Exchange during a special enrollment period if more than 60 days have elapsed since the individual’s loss of coverage as an employee; (ii)an individual who elects to enroll in continuation coverage will remain eligible to enroll in a qualified health plan offered through such Exchange during an open enrollment period or another special enrollment period for which the individual is eligible and may be eligible for financial assistance with respect to enrolling in such a qualified health plan; and(iii)an individual may apply for, and if eligible, enroll in Medicaid or the Children’s Health Insurance Program (CHIP), at any time, with no special enrollment period required;(D)information on consumer protections with respect to enrolling in a qualified health plan offered through such Exchange, including the requirement for such a qualified health plan to provide coverage for essential health benefits (as defined in section 1302(b) of the Patient Protection and Affordable Care Act) and the requirements applicable to such a qualified health plan under part A of title XXVII; and(E)information on the availability of financial assistance with respect to enrolling in a qualified health plan.

(2)

Effective date

The amendments made by paragraph (1) shall apply with respect to qualifying events occurring on or after the date that is 90 days after the date of the enactment of this Act.(c)

Internal Revenue Code of 1986

(1)

In general

Section 4980B(f)(6) of the Internal Revenue Code of 1986 is amended—(A)in subparagraph (D)—(i)in clause (ii), by striking under subparagraph (C) and inserting under clause (iii); and (ii)by redesignating clauses (i) and (ii) as subclauses (I) and (II), respectively, and moving the margin of each such subclause, as so redesignated, 2 ems to the right;(B)by redesignating subparagraphs (A) through (D) as clauses (i) through (iv), respectively, and moving the margin of each such clause, as so redesignated, 2 ems to the right;(C)by striking In accordance and inserting the following:

(A)

In general

In accordance

;

(D)by inserting after of such beneficiary’s rights under this subsection the following: in accordance with the notification requirements under subparagraph (C); and(E)by striking The requirements of subparagraph (B) and all that follows through such notification is made. and inserting the following:

(B)

Alternative means of compliance with requirement for notification of multiemployer plans by employers

The requirements of subparagraph (A)(ii) shall be considered satisfied in the case of a multiemployer plan in connection with a qualifying event described in paragraph (3)(B) if the plan provides that the determination of the occurrence of such qualifying event will be made by the plan administrator.(C)

Rules relating to notification of qualified beneficiaries by plan administrator

For purposes of subparagraph (A)(iv)—(i)any notification shall be made within 14 days (or, in the case of a group health plan which is a multiemployer plan, such longer period of time as may be provided in the terms of the plan) of the date on which the plan administrator is notified under clause (ii) or (iii) of subparagraph (A), whichever is applicable;(ii)any such notification to an individual who is a qualified beneficiary as the spouse of the covered employee shall be treated as notification to all other qualified beneficiaries residing with such spouse at the time such notification is made; and(iii)any such notification shall, with respect to each qualified beneficiary with respect to whom such notification is made, include information regarding any Exchange established under title I of the Patient Protection and Affordable Care Act through which such a qualified beneficiary may be eligible to enroll in a qualified health plan (as defined in section 1301 of the Patient Protection and Affordable Care Act), including—(I)the publicly accessible Internet website address for such Exchange;(II)the publicly accessible Internet website address for the Find Local Help directory maintained by the Department of Health and Human Services on the healthcare.gov Internet website (or a successor website);(III)a clear explanation that—(aa)an individual who is eligible for continuation coverage may be eligible to enroll instead, with financial assistance, in a qualified health plan offered through such Exchange, but, in the case that such individual elects to enroll in such continuation coverage and subsequently elects to terminate such continuation coverage before the period of such continuation coverage expires, such individual may not be eligible to enroll in a qualified health plan offered through such Exchange during a special enrollment period if more than 60 days have elapsed since the individual’s loss of coverage as an employee; (bb)an individual who elects to enroll in continuation coverage will remain eligible to enroll in a qualified health plan offered through such Exchange during an open enrollment period or another special enrollment period for which the individual is eligible and may be eligible for financial assistance with respect to enrolling in such a qualified health plan; and(cc)an individual may apply for, and if eligible, enroll in Medicaid or the Children’s Health Insurance Program (CHIP), at any time, with no special enrollment period required;(IV)information on consumer protections with respect to enrolling in a qualified health plan offered through such Exchange, including the requirement for such a qualified health plan to provide coverage for essential health benefits (as defined in section 1302(b) of the Patient Protection and Affordable Care Act) and the requirements applicable to such a qualified health plan under part A of title XXVII of the Public Health Service Act; and(V)information on the availability of financial assistance with respect to enrolling in a qualified health plan.

(2)

Effective date

The amendments made by paragraph (1) shall apply with respect to qualifying events occurring on or after the date that is 90 days after the date of the enactment of this Act.(d)

Model notices

Not later than 90 days after the date of the enactment of this Act, the Secretary of the Labor, in consultation with the Secretary of the Treasury and the Secretary of Health and Human Services, shall—(1)update the model Consolidated Omnibus Budget Reconciliation Act of 1985 (referred to in this subsection as COBRA) continuation coverage general notice and the model COBRA continuation coverage election notice developed by the Secretary of Labor for purposes of facilitating compliance of group health plans with the notification requirements under section 606 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1166) to include the information described in paragraph (3) of subsection (c) of such section 606, as added by subsection (a)(1);(2)provide an opportunity for consumer testing of each such notice, as so updated, to ensure that each such notice is clear and understandable to the average participant or beneficiary of a group health plan; and(3)rename the model COBRA continuation coverage general notice and the model COBRA continuation coverage election notice as the model COBRA continuation coverage and Affordable Care Act coverage general notice and the model COBRA continuation coverage and Affordable Care Act coverage election notice, respectively.