Beyond the regular annual requirements, your organization may also face compliance obligations that arise from specific events or changes in your benefits program or workforce. At Comply DIY, we’re here to guide you through these “as-needed” scenarios and ensure that you’re ready to respond appropriately when these situations arise.
Leave and Disability
Notices and requirements triggered by leaves of absence and disability accommodations.
Employers with 50 or more employees must provide eligible employees with up to 12 weeks of unpaid, job-protected leave per year for specified family and medical reasons, and must maintain the employee’s health coverage during the leave.
In addition to FMLA and ADA, many states have their own leave laws that employers must comply with. Whether it’s paid family leave, sick leave, or other types of mandated leave.
Employers must provide notices to employees informing them of their rights, benefits, and obligations under the state’s workers’ compensation laws.
Employers must inform employees about their rights to reasonable accommodation under the Americans with Disabilities Act (ADA) and similar state laws.
Employers must provide these notices when an employee is cleared to return to work following a period of leave or disability.
Termination
Documents and notices required when an employee leaves — voluntarily or otherwise.
These notices inform various parties, such as insurance carriers or retirement plan administrators, of changes in an employee’s employment status that could affect benefits eligibility.
This tool helps employers gather valuable feedback from departing employees, return company property, and provide any necessary final paperwork or instructions.
Each state has laws governing when a final paycheck must be delivered to a departing employee, which may vary depending on whether the employee quit or was terminated.
Employers must provide notifications to terminated employees about their eligibility to file for unemployment insurance benefits.
This notice informs departing employees of their right to continue their health insurance coverage under the company’s group health plan.
This notice is sent when a participant’s COBRA continuation coverage ends earlier than the maximum period.
This notice is sent when a participant is not entitled to the COBRA continuation coverage they requested.
Some states require employers to provide a notice of continuation coverage rights that is similar to the federal COBRA notice, often for smaller employers not subject to federal COBRA.
Employers must maintain certain personnel records for a specified duration after an employee’s termination, according to both federal and state laws.
On request, provide proof of prior health coverage (for self-insured employers). While an employee can request a Certificate of Creditable Coverage at any time, it usually happens when they leave employment and lose group health coverage.
Complete the form that confirms creditable coverage for employees transitioning to Medicare. It’s possible the employee will continue to work after signing up for Medicare, but employees often terminate their group health coverage when they enroll in Medicare.
Health Plan Changes
Any change to your health plan triggers documentation and notice requirements.
If a company makes changes to its health plan, it must amend its plan document and provide a summary of material modifications (SMM) to plan participants.
This document informs plan participants of important changes to their benefits or rights under the plan.
Any changes to your health plan may affect the Summary of Benefits and Coverage (SBC) that was previously distributed to employees. Ensure that the SBC is updated accurately to reflect any plan changes and redistributed to plan participants as required.
This notice informs plan participants of any significant changes to their health plan.
Other As-Needed Situations
Specific events that trigger compliance obligations outside the categories above.
When two or more companies are under common ownership, the combined employee count can impact the compliance obligations under various employment laws.
Notify affected individuals, the Secretary of HHS, and, in certain circumstances, the media of a breach of unsecured PHI.
These notices inform an employee when a court has ordered a child to be added to their health insurance plan.