Model Notices

Included is a list of Model Notices and documents that may be required for your employees throughout the year.  Please contact Kelly Insurance Agency if we can be of assistance in the delivery or explanation of this document library.

Notices listed below are categorized by the Grandfathered or Non-Grandfathered Status of your Health Plan.


         If your Plan is Grandfathered, the following Health Plan Notices are required henceforth:

1.  Grandfathered Model Notice;

2.  Dependent to Age 26 Notice (Coverage for Adult Children);

3.  Annual Limits on Essential Health Benefits Notice;

4.  Lifetime Limits on Essential Health Benefits:

5.  Pre-existing Conditions Exclusion for Children Under Age 19 Notice; and

6.  Patient Protections Notice-Prohibition on Rescissions 

        If your Plan is Non-Grandfathered, the following Health Plan Notices are required henceforth:

1.  2-6 Notices listed above under "Grandfathered", plus;

2.  Notice of Adverse Benefits Determination, Notice of Final External Review,
     Notice of Final Internal Adverse Benefits Determination and External Review Model Notice;

3.  Nondiscrimination Rules Extended to Insured Plans Notice;

4.  First Dollar Coverage for Preventative Care Notice; and

5.  Patient Protection-Provider Designation 


         Finally, all Plans-Grandfathered and Non-Grandfathered alike-must also provide the following ERISA Notices:


1.  WHCRA Notice (Women's Health and Cancer Right ACT);

2.  CHIPRA Notice (Children's Health Insurance Program Reauthorization Act);

3.  HIPAA Notice (for self-insured plans) (Contact your agent for assistance);

4.  Medicare Part D Notice; and

5.  MHPA Notice (Mental Health Parity Act) 


Grandfathered Plans will have 11 total Notice requirements under PPACA and ERISA. 

Non-Grandfathered Plans will have 16 total Notice requirements under PPACA and ERISA.

Healthcare Reform Notices
    Deliver by October 1, 2013
    1)  Exchange Notice Cover Letter
    2)  Exchange Notice
    3)  Final Legislative Update on Exchanges 

Other Helpful Documents:

Women's Health and Cancer Right ACT Payroll Stuffers
Employer's Tax Guide to Fringe Benefits
Initial COBRA Model Notice (Updated for Healthcare Reform)
Qualifying Event COBRA Model Notice (Updated for Healthcare Reform)