ACA Notices

Please see the notices below for information related to your health benefit rights.

COBRA Election Notice
Offers COBRA eligible members the opportunity to enroll. If COBRA triggering event has occurred, within 44 days of termination of employment, employee death, reduction of hours, within 14 days of notification of divorce or child aging out.

Cobra Model Notice

HIPAA Notice of Special Enrollment Rights
To eligible individuals notifies of special enrollment rights such as if you declined benefits during open enrollment, under certain circumstances you can become eligible for our plan coverage during the year.

HIPPA Notice

Model CHIP Notice
The DOL model notice is intended to inform employees of opportunities to receive premium assistance under CHIP.

Model Chip Notice

The USERRA Private Notice
USERRA Protects the job rights of individuals who voluntarily or involuntarily leave employment positions to undertake military service or certain types of service in the National Disaster Medical System

USERRA Private

VFF Annual Notices

VFF Annual Notice

The Medicare Part D Disclosure Notice 
(Creditable Coverage)

To eligible individuals it notifies participants as to whether the plan's prescription drug coverage is credible compared to Medicare Part D prescription drug coverage. In other words, is the group prescription drug coverage equal or better than the prescription benefits under Medicare Part D. This has a deadline of October 15, to give out to employees. ​

Medicare Part D Notice

This web site is not a legal document.  This web site is not a guarantee of coverage, eligibility, or provider status and is designed for informational illustration only.  Benefits outlined on this web site are subject to change at any time.  Please consult your benefit plan provider(s) or administrator(s) for legal documents regarding your plan and to check coverage and/or eligibility.