[Code of Federal Regulations] [Title 29, Volume 9] [Revised as of July 1, 2005] From the U.S. Government Printing Office via GPO Access [CITE: 29CFR2590.606-1] [Page 616-622] TITLE 29--LABOR CHAPTER XXV--EMPLOYEE BENEFITS SECURITY ADMINISTRATION, DEPARTMENT OF LABOR PART 2590_RULES AND REGULATIONS FOR GROUP HEALTH PLANS--Table of Contents Subpart A_Continuation Coverage, Qualified Medical Child Support Orders, Coverage for Adopted Children Sec. 2590.606-1 General notice of continuation coverage. Subpart A_Continuation Coverage, Qualified Medical Child Support Orders, Coverage for Adopted Children Sec. 2590.606-1 General notice of continuation coverage. 2590.606-2 Notice requirement for employers. 2590.606-3 Notice requirements for covered employees and qualified beneficiaries. 2590.606-4 Notice requirements for plan administrators. 2590.609-1 [Reserved] 2590.609-2 National Medical Support Notice. Subpart B_Health Coverage Portability, Nondiscrimination, and Renewability 2590.701-1 Basis and scope. 2590.701-2 Definitions. 2590.701-3 Limitations on preexisting condition exclusion period. 2590.701-4 Rules relating to creditable coverage. 2590.701-5 Evidence of creditable coverage. 2590.701-6 Special enrollment periods. 2590.701-7 HMO affiliation period as alternative to a preexisting condition exclusion. 2590.701-8 Interaction with the Family and Medical Leave Act. [Reserved] 2590.702 Prohibiting discrimination against participants and beneficiaries based on a health factor. 2590.703 Guaranteed renewability in multiemployer plans and multiple employer welfare arrangements. [Reserved] Subpart C_Other Requirements 2590.711 Standards relating to benefits for mothers and newborns. 2590.712 Parity in the application of certain limits to mental health benefits. Subpart D_General Provisions Related to Subparts B and C 2590.731 Preemption; State flexibility; construction. 2590.732 Special rules relating to group health plans. 2590.734 Enforcement. [Reserved] 2590.736 Applicability dates. Authority: 29 U.S.C. 1027, 1059, 1135, 1161-1168, 1169, 1181-1183, 1181 note, 1185, 1185a, 1185b, 1191, 1191a, 1191b, and 1191c, sec. 101(g), Public Law 104-191, 101 Stat. 1936; sec. 401(b), Public Law 105- 200, 112 Stat. 645 (42 U.S.C. 651 note); Secretary of Labor's Order 1- 2003, 68 FR 5374 (Feb. 3, 2003). Source: 62 FR 16941, Apr. 8, 1997, unless otherwise noted. (a) General. Pursuant to section 606(a)(1) of the Employee Retirement Income Security Act of 1974, as amended (the Act), the administrator of a group health plan subject to the continuation coverage requirements of part 6 of title I of the Act shall provide, in accordance with this section, written notice to each covered employee and spouse of the covered employee (if any) of the right to continuation coverage provided under the plan. (b) Timing of notice. (1) The notice required by paragraph (a) of this section shall be furnished to each employee and each employee's spouse, not later than the earlier of: (i) The date that is 90 days after the date on which such individual's coverage under the plan commences, or, if later, the date that is 90 days after the date on which the plan first becomes subject to the continuation coverage requirements; or (ii) The first date on which the administrator is required, pursuant to Sec. 2590.606-4(b), to furnish the covered employee, spouse, or dependent child of such employee notice of a qualified beneficiary's right to elect continuation coverage. (2) A notice that is furnished in accordance with paragraph (b)(1) of this section shall, for purposes of section 606(a)(1) of the Act, be deemed to be provided at the time of commencement of coverage under the plan. (3) In any case in which an administrator is required to furnish a notice to a covered employee or spouse pursuant to paragraph (b)(1)(ii) of this section, [[Page 617]] the furnishing of a notice to such individual in accordance with Sec. 2590.606-4(b) shall be deemed to satisfy the requirements of this section. (c) Content of notice. The notice required by paragraph (a) of this section shall be written in a manner calculated to be understood by the average plan participant and shall contain the following information: (1) The name of the plan under which continuation coverage is available, and the name, address and telephone number of a party or parties from whom additional information about the plan and continuation coverage can be obtained; (2) A general description of the continuation coverage under the plan, including identification of the classes of individuals who may become qualified beneficiaries, the types of qualifying events that may give rise to the right to continuation coverage, the obligation of the employer to notify the plan administrator of the occurrence of certain qualifying events, the maximum period for which continuation coverage may be available, when and under what circumstances continuation coverage may be extended beyond the applicable maximum period, and the plan's requirements applicable to the payment of premiums for continuation coverage; (3) An explanation of the plan's requirements regarding the responsibility of a qualified beneficiary to notify the administrator of a qualifying event that is a divorce, legal separation, or a child's ceasing to be a dependent under the terms of the plan, and a description of the plan's procedures for providing such notice; (4) An explanation of the plan's requirements regarding the responsibility of qualified beneficiaries who are receiving continuation coverage to provide notice to the administrator of a determination by the Social Security Administration, under title II or XVI of the Social Security Act (42 U.S.C. 401 et seq. or 1381 et seq.), that a qualified beneficiary is disabled, and a description of the plan's procedures for providing such notice; (5) An explanation of the importance of keeping the administrator informed of the current addresses of all participants or beneficiaries under the plan who are or may become qualified beneficiaries; and (6) A statement that the notice does not fully describe continuation coverage or other rights under the plan and that more complete information regarding such rights is available from the plan administrator and in the plan's SPD. (d) Single notice rule. A plan administrator may satisfy the requirement to provide notice in accordance with this section to a covered employee and the covered employee's spouse by furnishing a single notice addressed to both the covered employee and the covered employee's spouse, if, on the basis of the most recent information available to the plan, the covered employee's spouse resides at the same location as the covered employee, and the spouse's coverage under the plan commences on or after the date on which the covered employee's coverage commences, but not later than the date on which the notice required by this section is required to be provided to the covered employee. Nothing in this section shall be construed to create a requirement to provide a separate notice to dependent children who share a residence with a covered employee or a covered employee's spouse to whom notice is provided in accordance with this section. (e) Notice in summary plan description. A plan administrator may satisfy the requirement to provide notice in accordance with this section by including the information described in paragraphs (c)(1), (2), (3), (4), and (5) of this section in a summary plan description meeting the requirements of Sec. 2520.102-3 of this chapter furnished in accordance with paragraph (b) of this section. (f) Delivery of notice. The notice required by this section shall be furnished in a manner consistent with the requirements of Sec. 2520.104b-1 of this chapter, including paragraph (c) of that section relating to the use of electronic media. (g) Model notice. The appendix to this section contains a model notice that is intended to assist administrators in discharging the notice obligations of this section. Use of the model notice is not mandatory. The model notice reflects the requirements of this section [[Page 618]] as they would apply to single-employer group health plans and must be modified if used to provide notice with respect to other types of group health plans, such as multiemployer plans or plans established and maintained by employee organizations for their members. In order to use the model notice, administrators must appropriately add relevant information where indicated in the model notice, select among alternative language, and supplement the model notice to reflect applicable plan provisions. Items of information that are not applicable to a particular plan may be deleted. Use of the model notice, appropriately modified and supplemented, will be deemed to satisfy the notice content requirements of paragraph (c) of this section. (h) Applicability. This section shall apply to any notice obligation described in this section that arises on or after the first day of the first plan year beginning on or after November 26, 2004. [[Page 619]] [GRAPHIC] [TIFF OMITTED] TR26MY04.004 [[Page 620]] [GRAPHIC] [TIFF OMITTED] TR26MY04.005 [[Page 621]] [GRAPHIC] [TIFF OMITTED] TR26MY04.006 [[Page 622]] [GRAPHIC] [TIFF OMITTED] TR26MY04.007 [69 FR 30097, May 26, 2004; 69 FR 34921, June 23, 2004]