29 U.S.C. § 1166 — Notice requirements

Page 563 TITLE 29—LABOR § 1166 (Pub. L. 93–406, title I, § 605, as added Pub. L. 99–272, title X, § 10002(a), Apr. 7, 1986, 100 Stat. 230; amended Pub. L. 99–514, title XVIII, § 1895(d)(5)(B), Oct. 22, 1986, 100 Stat. 2939; Pub. L. 107–210, div. A, title II, § 203(e)(1), Aug. 6, 2002, 116 Stat. 969.) Editorial Notes REFERENCES IN TEXT Section 1166(4) of this title, referred to in subsec. (a)(1)(C)(ii), was redesignated as section 1166(a)(4) of this title by Pub. L. 101–239, title VII, § 7891(d)(1)(A)(ii)(I), Dec. 19, 1989, 103 Stat. 2445. Section 2701 of the Public Health Service Act, re- ferred to in subsec. (b)(3), was classified to section 300gg of Title 42, The Public Health and Welfare, was renum- bered section 2704, effective for plan years beginning on or after Jan. 1, 2014, with certain exceptions, and amended, by Pub. L. 111–148, title I, §§ 1201(2), 1563(c)(1), formerly § 1562(c)(1), title X, § 10107(b)(1), Mar. 23, 2010, 124 Stat. 154, 264, 911, and was transferred to section 300gg–3 of Title 42. A new section 2701, related to fair health insurance premiums, was added and amended by Pub. L. 111–148, title I, § 1201(4), title X, § 10103(a), Mar. 23, 2010, 124 Stat. 155, 892, and is classified to section 300gg of Title 42. AMENDMENTS 2002—Pub. L. 107–210 designated existing provisions as subsec. (a), inserted heading, and added subsec. (b). 1986—Par. (2). Pub. L. 99–514 inserted ‘‘of continuation coverage’’ after ‘‘any election’’ and inserted at end ‘‘If there is a choice among types of coverage under the plan, each qualified beneficiary is entitled to make a separate selection among such types of coverage.’’ Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2002 AMENDMENT Amendment by Pub. L. 107–210 applicable to petitions for certification filed under part 2 or 3 of subchapter II of chapter 12 of Title 19, Customs Duties, on or after the date that is 90 days after Aug. 6, 2002, except as oth- erwise provided, see section 151 of Pub. L. 107–210, set out as a note preceding section 2271 of Title 19. EFFECTIVE DATE OF 1986 AMENDMENT Amendment by Pub. L. 99–514 effective, except as oth- erwise provided, as if included in enactment of the Con- solidated Omnibus Budget Reconciliation Act of 1985, Pub. L. 99–272, see section 1895(e) of Pub. L. 99–514, set out as a note under section 162 of Title 26, Internal Rev- enue Code. CONSTRUCTION OF 2002 AMENDMENT Nothing in amendment by Pub. L. 107–210, other than provisions relating to COBRA continuation coverage and reporting requirements, to be construed as creating new mandate on any party regarding health insurance coverage, see section 203(f) of Pub. L. 107–210, set out as a Construction note under section 35 of Title 26, Inter- nal Revenue Code. PLAN AMENDMENTS NOT REQUIRED UNTIL JANUARY 1, 1989 For provisions directing that if any amendments made by subtitle A or subtitle C of title XI [§§ 1101–1147 and 1171–1177] or title XVIII [§§ 1800–1899A] of Pub. L. 99–514 require an amendment to any plan, such plan amendment shall not be required to be made before the first plan year beginning on or after Jan. 1, 1989, see section 1140 of Pub. L. 99–514, as amended, set out as a note under section 401 of Title 26, Internal Revenue Code. § 1166. Notice requirements (a) In general In accordance with regulations prescribed by the Secretary— (1) the group health plan shall provide, at the time of commencement of coverage under the plan, written notice to each covered em- ployee and spouse of the employee (if any) of the rights provided under this subsection, (2) the employer of an employee under a plan must notify the administrator of a qualifying event described in paragraph (1), (2), (4), or (6) of section 1163 of this title within 30 days (or, in the case of a group health plan which is a multiemployer plan, such longer period of time as may be provided in the terms of the plan) of the date of the qualifying event, (3) each covered employee or qualified bene- ficiary is responsible for notifying the admin- istrator of the occurrence of any qualifying event described in paragraph (3) or (5) of sec- tion 1163 of this title within 60 days after the date of the qualifying event and each qualified beneficiary who is determined, under title II or XVI of the Social Security Act [42 U.S.C. 401 et seq., 1381 et seq.], to have been disabled at any time during the first 60 days of continu- ation coverage under this part is responsible for notifying the plan administrator of such determination within 60 days after the date of the determination and for notifying the plan administrator within 30 days after the date of any final determination under such title or ti- tles that the qualified beneficiary is no longer disabled, and (4) the administrator shall notify— (A) in the case of a qualifying event de- scribed in paragraph (1), (2), (4), or (6) of sec- tion 1163 of this title, any qualified bene- ficiary with respect to such event, and (B) in the case of a qualifying event de- scribed in paragraph (3) or (5) of section 1163 of this title where the covered employee no- tifies the administrator under paragraph (3), any qualified beneficiary with respect to such event, of such beneficiary’s rights under this sub- section. (b) Alternative means of compliance with re- quirements for notification of multiemployer plans by employers The requirements of subsection (a)(2) shall be considered satisfied in the case of a multiem- ployer plan in connection with a qualifying event described in paragraph (2) of section 1163 of this title if the plan provides that the deter- mination of the occurrence of such qualifying event will be made by the plan administrator. (c) Rules relating to notification of qualified beneficiaries by plan administrator For purposes of subsection (a)(4), any notifica- tion shall be made within 14 days (or, in the case of a group health plan which is a multiemployer plan, such longer period of time as may be pro- vided in the terms of the plan) of the date on which the administrator is notified under para- graph (2) or (3), whichever is applicable, and any such notification to an individual who is a quali- Page 564 TITLE 29—LABOR § 1167 fied beneficiary as the spouse of the covered em- ployee shall be treated as notification to all other qualified beneficiaries residing with such spouse at the time such notification is made. (Pub. L. 93–406, title I, § 606, as added Pub. L. 99–272, title X, § 10002(a), Apr. 7, 1986, 100 Stat. 230; amended Pub. L. 99–509, title IX, § 9501(d)(2), Oct. 21, 1986, 100 Stat. 2077; Pub. L. 99–514, title XVIII, § 1895(d)(6)(B), Oct. 22, 1986, 100 Stat. 2939; Pub. L. 101–239, title VI, § 6703(c), title VII, § 7891(d)(1)(A), Dec. 19, 1989, 103 Stat. 2296, 2445; Pub. L. 104–191, title IV, § 421(b)(2), Aug. 21, 1996, 110 Stat. 2088.) Editorial Notes REFERENCES IN TEXT The Social Security Act, referred to in subsec. (a)(3), is act Aug. 14, 1935, ch. 531, 49 Stat. 620, as amended. Ti- tles II and XVI of the Social Security Act are classified generally to subchapters II (§ 401 et seq.) and XVI (§ 1381 et seq.), respectively, of chapter 7 of Title 42, The Pub- lic Health and Welfare. For complete classification of this Act to the Code, see section 1305 of Title 42 and Ta- bles. AMENDMENTS 1996—Subsec. (a)(3). Pub. L. 104–191 substituted ‘‘at any time during the first 60 days of continuation cov- erage under this part’’ for ‘‘at the time of a qualifying event described in section 1163(2) of this title’’. 1989—Pub. L. 101–239, § 7891(d)(1)(A)(ii), designated first sentence as subsec. (a), added subsec. (b), des- ignated second sentence as subsec. (c), and substituted ‘‘For purposes of subsection (a)(4)’’ for ‘‘For purposes of paragraph (4)’’. Pub. L. 101–239, § 7891(d)(1)(A)(i)(II), inserted in last sentence ‘‘(or, in the case of a group health plan which is a multiemployer plan, such longer period of time as may be provided in the terms of the plan)’’ after ‘‘14 days’’. Pub. L. 101–239, § 7891(d)(1)(A)(i)(I), inserted ‘‘(or, in the case of a group health plan which is a multiem- ployer plan, such longer period of time as may be pro- vided in the terms of the plan)’’ after ‘‘30 days’’ in par. (2). Pub. L. 101–239, § 6703(c), inserted ‘‘and each qualified beneficiary who is determined, under title II or XVI of the Social Security Act, to have been disabled at the time of a qualifying event described in section 1163(2) of this title is responsible for notifying the plan adminis- trator of such determination within 60 days after the date of the determination and for notifying the plan ad- ministrator within 30 days after the date of any final determination under such title or titles that the quali- fied beneficiary is no longer disabled’’ before comma in par. (3). 1986—Par. (2). Pub. L. 99–509 substituted ‘‘(4), or (6)’’ for ‘‘or (4)’’. Par. (3). Pub. L. 99–514 inserted ‘‘within 60 days after the date of the qualifying event’’. Par. (4)(A). Pub. L. 99–509 substituted ‘‘(4), or (6)’’ for ‘‘or (4)’’. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 1996 AMENDMENT Amendment by Pub. L. 104–191 effective Jan. 1, 1997, regardless of whether qualifying event occurred before, on, or after such date, see section 421(d) of Pub. L. 104–191 set out as a note under section 4980B of Title 26, Internal Revenue Code. EFFECTIVE DATE OF 1989 AMENDMENT Amendment by section 6703(c) of Pub. L. 101–239 appli- cable to plan years beginning on or after Dec. 19, 1989, regardless of whether the qualifying event occurred be- fore, on, or after such date, see section 6703(d) of Pub. L. 101–239, set out as a note under section 1162 of this title. Amendment by section 7891(d)(1)(A) of Pub. L. 101–239 applicable with respect to plan years beginning on or after Jan. 1, 1990, see section 7891(d)(1)(C) of Pub. L. 101–239, set out as a note under section 4980B of Title 26, Internal Revenue Code. EFFECTIVE DATE OF 1986 AMENDMENTS Amendment by Pub. L. 99–514 applicable only with re- spect to qualifying events occurring after Oct. 22, 1986, see section 1895(d)(6)(D) of Pub. L. 99–514, set out as a note under section 162 of Title 26, Internal Revenue Code. Amendment by Pub. L. 99–509 effective, except as oth- erwise provided, as if included in title X of the Consoli- dated Omnibus Budget Reconciliation Act of 1985, Pub. L. 99–272, see section 9501(e) of Pub. L. 99–509, set out as a note under section 162 of Title 26. PLAN AMENDMENTS NOT REQUIRED UNTIL JANUARY 1, 1989 For provisions directing that if any amendments made by subtitle A or subtitle C of title XI [§§ 1101–1147 and 1171–1177] or title XVIII [§§ 1800–1899A] of Pub. L. 99–514 require an amendment to any plan, such plan amendment shall not be required to be made before the first plan year beginning on or after Jan. 1, 1989, see section 1140 of Pub. L. 99–514, as amended, set out as a note under section 401 of Title 26, Internal Revenue Code. NOTIFICATION TO COVERED EMPLOYEES Pub. L. 99–272, title X, § 10002(e), Apr. 7, 1986, 100 Stat. 232, provided that: ‘‘At the time that the amendments made by this section [enacting this part and amending section 1132 of this title] apply to a group health plan (within the meaning of section 607(1) of the Employee Retirement Income Security Act of 1974 [29 U.S.C. 1167(1)]), the plan shall notify each covered employee, and spouse of the employee (if any), who is covered under the plan at that time of the continuation cov- erage required under part 6 of subtitle B of title I of such Act [this part]. The notice furnished under this subsection is in lieu of notice that may otherwise be re- quired under section 606(1) of such Act [29 U.S.C. 1166(1)] with respect to such individuals.’’ § 1167. Definitions and special rules For purposes of this part— (1) Group health plan The term ‘‘group health plan’’ means an em- ployee welfare benefit plan providing medical care (as defined in section 213(d) of title 26) to participants or beneficiaries directly or through insurance, reimbursement, or other- wise. Such term shall not include any plan substantially all of the coverage under which is for qualified long-term care services (as de- fined in section 7702B(c) of title 26). Such term shall not include any qualified small employer health reimbursement arrangement (as de- fined in section 9831(d)(2) of title 26). (2) Covered employee The term ‘‘covered employee’’ means an in- dividual who is (or was) provided coverage under a group health plan by virtue of the per- formance of services by the individual for 1 or more persons maintaining the plan (including as an employee defined in section 401(c)(1) of title 26).