Under the Patient Protection and Affordable Care Act (the "PPACA"), group health plans are obligated to notify participants no later than the first day of the first plan year beginning on or after September 23, 2010 (January 1, 2011 for calendar year plans) of the following:

· Extension of Dependent Coverage to Age 26. The PPACA requires all group health plans which offer dependent child coverage to extend that coverage to adult children up to age 26. This extension includes providing coverage for adult children up to age 26 who may have previously been excluded. The PPACA provides special enrollment rights for children up to age 26 who were previously not covered and will become eligible effective the first day of the new plan year beginning on or after September 23, 2010. The adult child must be given an opportunity to enroll for a period of at least 30 days beginning no later than the first day of the plan year. If coverage is elected during this period, coverage must be retroactive to the first day of the plan year (e.g., January 1, 2011 for calendar years). Notification of this extension of coverage may be included with enrollment materials as long as the notice is prominent.

· Extinguishment of Lifetime Limits. The PPACA prohibits group health plans from imposing overall lifetime limits on the dollar value of benefits provided to participants. For plan participants who previously reached a lifetime limit but are still eligible for coverage as of the first day of a new plan year, the plan must notify the participant that the lifetime limit no longer applies. In addition to notifying the participant, the plan must also provide a special enrollment opportunity of at least 30 days for the participant. Where a participant enrolls in a group health plan during such an enrollment period, coverage must be retroactive to the first day of the plan year (e.g., January 1, 2011 for calendar year plans). The notice that lifetime limits no longer apply can be included with other enrollment materials, but the notice must be prominently displayed.

· Patient Protections. The PPACA also requires all group health plans, except grandfathered plans, to extend certain patient protections effective the first plan year beginning after September 23, 2010. If the plan provides coverage through a provider network and requires the participant to designate a primary care provider, the plan participants must be permitted to designate any participating primary care provider available to accept them. If the participant is a child, enrollees must be permitted to designate any available participating pediatrician. Additionally, if the plan provides obstetrical or gynecological care and requires the participant to designate an in-network primary care provider, the plan cannot require a referral for a female enrollee to seek in-network care for an OB-GYN. The notice of these rights must be provided to participants whenever they are provided with a summary plan description or other description of the plan's benefits.

Model notification language and frequently asked questions for each of the above provisions are available on the Department of Labor website at: http://www.dol.gov/ebsa/healthreform/index.html.

If you have any questions please contact: Edward C. Hammond at (248) 988-1821 - ehammond@clarkhill.com , John P. Schneider at (616) 608-1108 - jschneider@clarkhill.com or Kristi R. Gauthier at (248) 988-5854 - kgauthier@clarkhill.com.

To find out more about Clark Hill and our Labor and Employment Practice Group, visit clarkhill.com or call 800.949.3124

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