[Code of Federal Regulations]

[Title 29, Volume 9]

[Revised as of July 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 29CFR2590.606-3]



[Page 666-669]

 

                             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.  2590.606-3  Notice requirements for covered employees and qualified 

beneficiaries.



    (a) General. In accordance with the authority of sections 505 and 

606(a)(3) of the Employee Retirement Income Security Act of 1974, as 

amended (the Act), this section sets forth requirements for group health 

plans subject to the continuation coverage requirements of part 6 of 

title I of the Act with respect to the responsibility of



[[Page 667]]



covered employees and qualified beneficiaries to provide the following 

notices to administrators:

    (1) Notice of the occurrence of a qualifying event that is a divorce 

or legal separation of a covered employee from his or her spouse;

    (2) Notice of the occurrence of a qualifying event that is a 

beneficiary's ceasing to be covered under a plan as a dependent child of 

a participant;

    (3) Notice of the occurrence of a second qualifying event after a 

qualified beneficiary has become entitled to continuation coverage with 

a maximum duration of 18 (or 29) months;

    (4) Notice that a qualified beneficiary entitled to receive 

continuation coverage with a maximum duration of 18 months has been 

determined 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.) 

(SSA), to be disabled at any time during the first 60 days of 

continuation coverage; and

    (5) Notice that a qualified beneficiary, with respect to whom a 

notice described in paragraph (a)(4) of this section has been provided, 

has subsequently been determined by the Social Security Administration, 

under title II or XVI of the SSA to no longer be disabled.

    (b) Reasonable procedures. (1) A plan subject to the continuation 

coverage requirements shall establish reasonable procedures for the 

furnishing of the notices described in paragraph (a) of this section.

    (2) For purposes of this section, a plan's notice procedures shall 

be deemed reasonable only if such procedures:

    (i) Are described in the plan's summary plan description required by 

Sec.  2520.102-3 of this chapter;

    (ii) Specify the individual or entity designated to receive such 

notices;

    (iii) Specify the means by which notice may be given;

    (iv) Describe the information concerning the qualifying event or 

determination of disability that the plan deems necessary in order to 

provide continuation coverage rights consistent with the requirements of 

the Act; and

    (v) Comply with the requirements of paragraphs (c), (d), and (e) of 

this section.

    (3) A plan's procedures will not fail to be reasonable, pursuant to 

this section, solely because the procedures require a covered employee 

or qualified beneficiary to utilize a specific form to provide notice to 

the administrator, provided that any such form is easily available, 

without cost, to covered employees and qualified beneficiaries.

    (4) If a plan has not established reasonable procedures for 

providing a notice required by this section, such notice shall be deemed 

to have been provided when a written or oral communication identifying a 

specific event is made in a manner reasonably calculated to bring the 

information to the attention of any of the following:

    (i) In the case of a single-employer plan, the person or 

organizational unit that customarily handles employee benefits matters 

of the employer;

    (ii) In the case of a plan to which more than one unaffiliated 

employer contributes, or which is established or maintained by an 

employee organization, either the joint board, association, committee, 

or other similar group (or any member of any such group) administering 

the plan, or the person or organizational unit to which claims for 

benefits under the plan customarily are referred; or

    (iii) In the case of a plan the benefits of which are provided or 

administered by an insurance company, insurance service, or other 

similar organization subject to regulation under the insurance laws of 

one or more States, the person or organizational unit that customarily 

handles claims for benefits under the plan or any officer of the 

insurance company, insurance service, or other similar organization.

    (c) Periods of time for providing notice. A plan may establish a 

reasonable period of time for furnishing any of the notices described in 

paragraph (a) of this section, provided that any time limit imposed by 

the plan with respect to a particular notice may not be shorter than the 

time limit described in this paragraph (c) with respect to that notice.



[[Page 668]]



    (1) Time limits for notices of qualifying events. The period of time 

for furnishing a notice described in paragraph (a)(1), (2), or (3) of 

this section may not end before the date that is 60 days after the 

latest of:

    (i) The date on which the relevant qualifying event occurs;

    (ii) The date on which the qualified beneficiary loses (or would 

lose) coverage under the plan as a result of the qualifying event; or

    (iii) The date on which the qualified beneficiary is informed, 

through the furnishing of the plan's summary plan description or the 

notice described in Sec.  2590.606-1, of both the responsibility to 

provide the notice and the plan's procedures for providing such notice 

to the administrator.

    (2) Time limits for notice of disability determination. (i) Subject 

to paragraph (c)(2)(ii) of this section, the period of time for 

furnishing the notice described in paragraph (a)(4) of this section may 

not end before the date that is 60 days after the latest of:

    (A) The date of the disability determination by the Social Security 

Administration;

    (B) The date on which a qualifying event occurs;

    (C) The date on which the qualified beneficiary loses (or would 

lose) coverage under the plan as a result of the qualifying event; or

    (D) The date on which the qualified beneficiary is informed, through 

the furnishing of the summary plan description or the notice described 

in Sec.  2590.606-1, of both the responsibility to provide the notice 

and the plan's procedures for providing such notice to the 

administrator.

    (ii) Notwithstanding paragraph (c)(2)(i) of this section, a plan may 

require the notice described in paragraph (a)(4) of this section to be 

furnished before the end of the first 18 months of continuation 

coverage.

    (3) Time limits for notice of change in disability status. The 

period of time for furnishing the notice described in paragraph (a)(5) 

of this section may not end before the date that is 30 days after the 

later of:

    (i) The date of the final determination by the Social Security 

Administration, under title II or XVI of the SSA, that the qualified 

beneficiary is no longer disabled; or

    (ii) The date on which the qualified beneficiary is informed, 

through the furnishing of the plan's summary plan description or the 

notice described in Sec.  2590.606-1, of both the responsibility to 

provide the notice and the plan's procedures for providing such notice 

to the administrator.

    (d) Required contents of notice. (1) A plan may establish reasonable 

requirements for the content of any notice described in this section, 

provided that a plan may not deem a notice to have been provided 

untimely if such notice, although not containing all of the information 

required by the plan, is provided within the time limit established 

under the plan in conformity with paragraph (c) of this section, and the 

administrator is able to determine from such notice the plan, the 

covered employee and qualified beneficiary(ies), the qualifying event or 

disability, and the date on which the qualifying event (if any) 

occurred.

    (2) An administrator may require a notice that does not contain all 

of the information required by the plan to be supplemented with the 

additional information necessary to meet the plan's reasonable content 

requirements for such notice in order for the notice to be deemed to 

have been provided in accordance with this section.

    (e) Who may provide notice. With respect to each of the notice 

requirements of this section, any individual who is either the covered 

employee, a qualified beneficiary with respect to the qualifying event, 

or any representative acting on behalf of the covered employee or 

qualified beneficiary may provide the notice, and the provision of 

notice by one individual shall satisfy any responsibility to provide 

notice on behalf of all related qualified beneficiaries with respect to 

the qualifying event.

    (f) Plan provisions. To the extent that a plan provides a covered 

employee or qualified beneficiary a period of time longer than that 

specified in this section to provide notice to the administrator, the 

terms of the plan shall govern the time frame for such notice.

    (g) Additional rights to continuation coverage. Nothing in this 

section shall



[[Page 669]]



be construed to preclude a plan from providing, in accordance with its 

terms, continuation coverage to a qualified beneficiary although a 

notice requirement of this section was not satisfied.

    (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.



[69 FR 30097, May 26, 2004]