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Employers who sponsor group health plans need to be prepared for open enrollment. They need to be aware of the legislative modifications affecting the administration and design of their health plans for plan years beginning on or after January 1, 2024.

The Affordable Care Act’s (ACA) affordability percentage and cost-sharing caps for high deductible health plans (HDHPs) are restrictions that are annually adjusted for inflation. Therefore, employers should check the design of their health plan to see if it has been modified as needed to account for these changes.

A revised summary plan description (SPD) or a summary of substantial modifications (SMM) should be used to inform participants of any adjustments to a health plan’s benefits for the 2024 plan year.

Health plan sponsors should also make sure that, where necessary, certain participant communications, such the summary of benefits and coverage (SBC), are included in their open enrollment materials. Some participant reminders must also be given on an annual basis or at sign-up. Employers should take into account including these notices in their open enrollment materials to reduce expenses and streamline administration.

Please DOWNLOAD the Compliance Overview HERE.

It explains the Plan Design Changes in:

  • ACA Affordability Standard
  • Out-of-Pocket Maximum Limits
  • Preventive Care Benefits
  • Coverage for COVID-19 Vaccines, Testing and Treatment
  • Health FSA Contributions
  • HDHP and HSA Limits for 2024
  • HDHP Design Option – Telehealth
  • Mental Health Parity – Required Comparative Analysis for NQTLs

It also outlines Open Enrollment Notices, such as:

  • Summary of Benefits and Coverage
  • Medicare Part D Notices
  • Annual CHIP Notices
  • Initial COBRA Notices
  • SPDs
  • Notices of Patient Protections
  • Grandfathered Plan Notices
  • Notices of HIPAA Special Enrollment Rights
  • HIPAA Privacy Notices
  • WHCRA Notices
  • SARs
  • Wellness Program Notices
  • ICHRA Notices