[SAMPLE] NOTICE OF SUMMARY MATERIAL MODIFICATION …



Notice of Summary Material Modification (SMM). If this SMM was delivered to your email and you would like to receive a hard copy, you may request same at no charge by contacting [HR administrator name and contact info][Insert Plan Name] Participant and Beneficiaries, This document serves as notice of material changes to the [employer name] sponsored health benefit plan(s). It describes the changes that affect your benefit plans and updates the Summary Plan Description (SPD).Read this Summary of Material Modification (SMM) carefully and retain this document with your copy of the SPD for future reference. Contact us at XXXXXXX if you have any questions. Impacted Plans (delete those not applicable)Medical PlanHealth Savings AccountHealth Reimbursement AccountFlexible Spending Account Changes to Your Plan (delete those not applicable)New COVID-19 federal laws called the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief and Economic Security Act (CARES Act) allow certain changes to our group health benefit plan(s). These changes impact participant benefits as follows:High-Deductible Health Plan (HDHP) with a Health Savings Account (HSA)Generally, the HDHP may not pay medical expenses (other than preventive care) until your annual minimum deductible has been reached. However, the new COVID-19 laws now allow HDHPs to pay for the following benefits before the required minimum deductible is met: (delete bullets 3 to 5 if not applicable, these are optional)The plan covers 100% COVID-19 Diagnostic testing (including tests without an Emergency Use Authorization (EUA) by the FDA) before plan deductibles are met.When available, the plan will cover approved COVID-19 vaccines before the deductible is met (within 15 days of receiving a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force or a recommendation from the Advisory Committee on Immunization Practices (ACIP).The plan covers COVID-19 related treatment before plan deductibles are met.The plan covers COVID-19 related benefits obtained through telehealth (and/or other remote care services) without a deductible.The plan covers COVID-19 related benefits and any other non-COVID-19 related healthcare provided through telehealth (and/or other remote care services) without a deductible. Note the plan pays either the rate specified in a contract between the provider and the insurer, or, if there is no contract, the cash price posted by the provider. These changes are effective April 1, 2020 through December 31, 2020.Over-The-Counter (OTC) Medicines and Drugs without a Prescription and Menstrual Care ProductsGenerally, OTC medicines and drugs (except insulin) are not qualifying medical expenses that may be paid for (or reimbursed) on a tax-free basis by your Health Savings Accounts (HSA), Health Reimbursement Arrangement (HRA), and/or Flexible Spending Accounts (FSA). However, under the new COVID-19 laws, these are now allowable expenses. In addition, menstrual care products (including tampons, pads, liners, cups, sponges or similar products used for menstruation) are also now eligible purchases (or reimbursements) through your HSA, HRA, or FSA. These changes are effective for expenses incurred on or after January 1, 2020. Emergency Paid Sick Leave & Extended Family Medical Leave New laws allow you in certain circumstances to receive additional time off between April 1, 2020 through December 31, 2020 for COVID-19 related reasons through emergency paid sick leave and extended paid/unpaid family medical leave as described here: Employees have the right to remain on the plan if using unpaid/paid leave under the new emergency paid sick leave and extended FMLA. If you believe any of these leave provisions apply to you, please contact XXXXXXXXX for leave approval, additional details, as well as information explaining how your share of insurance premiums will be handled, if applicable. Furlough Generally, you must have an average of XXX (130) hours of service per month to be eligible for the group health benefits. However, if you are or have been furloughed due to the impact of COVID-19 and have a reduction of hours of service below the minimum required hours (or no hours of service) you may still be eligible to continue participation in the group medical plan during the furlough for a period determined by the Plan. If applicable, you will be provided additional details regarding the furlough, continuation of medical insurance, and premiums. Special Mid-year Enrollment WindowGenerally, we do not offer a mid-year enrollment period unless an individual falls into the allowed exception under our plan policies which are consistent with the law. However, due to the impact of COVID-19, we are offering a special mid-year enrollment window to allow employees who did not elect coverage during the regular enrollment period to sign up for coverage and additional details are forthcoming. Important. Refer to your Summary Plan Description (SPD) and plan documents for details of your benefit plans. If you have questions regarding this modification, contact the Plan Administrator at: Company Name: Contact Person: Company Address: Contact Email: Contact Phone Number: General Plan Information. Plan Name: Plan Number: Plan Sponsor/Plan Administrator: Insert Contact Information. It must be listed with name/role of person (preferably name) and email, address & phone. Include insurer /Third-Party Administrator if relevant for these provisions. ................
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