iUnder the Consumer Coverage Disclosure Act (CCDA) signed by Governor Pritzker in late August, employers that offer fully insured medical benefits must provide eligible employees with a new notice that compares their coverage to the “essential health benefits” required for coverage obtained through Get Covered Illinois, the Illinois insurance marketplace. The CCDA applies to all employers, regardless of size, if they have employees in Illinois. The Illinois Department of Labor (IDOL) is responsible for enforcement.
The CCDA requires only that employers provide the notice that compares their policy to the essential benefits available through Get Covered Illinois. It does not require employers' plans to provide all of the essential benefits.
What types of benefits trigger the notice requirement?
The CCDA applies if an employer provides fully insured medical benefits. It does not apply to an employer that provides benefits entirely through a self-insured health plan.
When should the notice be provided?
The notice must be provided to employees who are eligible for coverage when they are hired and annually thereafter. In addition, employees can request a copy of the notice at any time.
How should the notice be provided?
The notice can be provided by email, by posting to a website, or by hard copy. Employers should retain records of how and when the notice is provided, in case the IDOL requests proof of compliance.
What information should the notice contain?
The notice must show the coverage offered under the employer’s policy with respect to the essential benefits required for policies sold on the Illinois insurance marketplace, including:
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Ambulatory patient services
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Emergency room and hospitalization services
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Mental health and substance use disorder services
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Pregnancy, maternity, and newborn care
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Prescription drugs
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Preventive and wellness services and chronic disease management
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Rehabilitative services
What are the penalties for non-compliance?
|
Employer Size |
Max Penalty |
|
|
Fewer than four employees |
First offense |
$500 |
|
|
Second offense |
$1,000 |
|
|
Subsequent offenses |
$3,000 |
|
Four or more employees |
First offense |
$1,000 |
|
|
Second offense |
$3,000 |
|
|
Subsequent offenses |
$5,000 |
The IDOL has the discretion to determine the exact amount of the penalty based upon the facts and circumstances. Of course, how IDOL chooses to exercise this discretion remains to be seen.
What are the next steps?
Employers that provide fully insured medical benefits to Illinois employees should ask if their brokers and insurers will prepare or assist with the required disclosures. If not, employers should be sure to take responsibility for preparing and providing the notices themselves.
