(a) General. In accordance with the authority of sections 505 and
606(a)(3) of the Employee Retirement Income Security Act of 1974, as
amended (the Act), this section sets forth requirements for group health
plans subject to the continuation coverage requirements of part 6 of
title I of the Act with respect to the responsibility of
[[Page 623]]
covered employees and qualified beneficiaries to provide the following
notices to administrators:
(1) Notice of the occurrence of a qualifying event that is a divorce
or legal separation of a covered employee from his or her spouse;
(2) Notice of the occurrence of a qualifying event that is a
beneficiary's ceasing to be covered under a plan as a dependent child of
a participant;
(3) Notice of the occurrence of a second qualifying event after a
qualified beneficiary has become entitled to continuation coverage with
a maximum duration of 18 (or 29) months;
(4) Notice that a qualified beneficiary entitled to receive
continuation coverage with a maximum duration of 18 months has been
determined by the Social Security Administration, under title II or XVI
of the Social Security Act (42 U.S.C. 401 et seq. or 1381 et seq.)
(SSA), to be disabled at any time during the first 60 days of
continuation coverage; and
(5) Notice that a qualified beneficiary, with respect to whom a
notice described in paragraph (a)(4) of this section has been provided,
has subsequently been determined by the Social Security Administration,
under title II or XVI of the SSA to no longer be disabled.
(b) Reasonable procedures. (1) A plan subject to the continuation
coverage requirements shall establish reasonable procedures for the
furnishing of the notices described in paragraph (a) of this section.
(2) For purposes of this section, a plan's notice procedures shall
be deemed reasonable only if such procedures:
(i) Are described in the plan's summary plan description required by
Sec. 2520.102-3 of this chapter;
(ii) Specify the individual or entity designated to receive such
notices;
(iii) Specify the means by which notice may be given;
(iv) Describe the information concerning the qualifying event or
determination of disability that the plan deems necessary in order to
provide continuation coverage rights consistent with the requirements of
the Act; and
(v) Comply with the requirements of paragraphs (c), (d), and (e) of
this section.
(3) A plan's procedures will not fail to be reasonable, pursuant to
this section, solely because the procedures require a covered employee
or qualified beneficiary to utilize a specific form to provide notice to
the administrator, provided that any such form is easily available,
without cost, to covered employees and qualified beneficiaries.
(4) If a plan has not established reasonable procedures for
providing a notice required by this section, such notice shall be deemed
to have been provided when a written or oral communication identifying a
specific event is made in a manner reasonably calculated to bring the
information to the attention of any of the following:
(i) In the case of a single-employer plan, the person or
organizational unit that customarily handles employee benefits matters
of the employer;
(ii) In the case of a plan to which more than one unaffiliated
employer contributes, or which is established or maintained by an
employee organization, either the joint board, association, committee,
or other similar group (or any member of any such group) administering
the plan, or the person or organizational unit to which claims for
benefits under the plan customarily are referred; or
(iii) In the case of a plan the benefits of which are provided or
administered by an insurance company, insurance service, or other
similar organization subject to regulation under the insurance laws of
one or more States, the person or organizational unit that customarily
handles claims for benefits under the plan or any officer of the
insurance company, insurance service, or other similar organization.
(c) Periods of time for providing notice. A plan may establish a
reasonable period of time for furnishing any of the notices described in
paragraph (a) of this section, provided that any time limit imposed by
the plan with respect to a particular notice may not be shorter than the
time limit described in this paragraph (c) with respect to that notice.
[[Page 624]]
(1) Time limits for notices of qualifying events. The period of time
for furnishing a notice described in paragraph (a)(1), (2), or (3) of
this section may not end before the date that is 60 days after the
latest of:
(i) The date on which the relevant qualifying event occurs;
(ii) The date on which the qualified beneficiary loses (or would
lose) coverage under the plan as a result of the qualifying event; or
(iii) The date on which the qualified beneficiary is informed,
through the furnishing of the plan's summary plan description or the
notice described in Sec. 2590.606-1, of both the responsibility to
provide the notice and the plan's procedures for providing such notice
to the administrator.
(2) Time limits for notice of disability determination. (i) Subject
to paragraph (c)(2)(ii) of this section, the period of time for
furnishing the notice described in paragraph (a)(4) of this section may
not end before the date that is 60 days after the latest of:
(A) The date of the disability determination by the Social Security
Administration;
(B) The date on which a qualifying event occurs;
(C) The date on which the qualified beneficiary loses (or would
lose) coverage under the plan as a result of the qualifying event; or
(D) The date on which the qualified beneficiary is informed, through
the furnishing of the summary plan description or the notice described
in Sec. 2590.606-1, of both the responsibility to provide the notice
and the plan's procedures for providing such notice to the
administrator.
(ii) Notwithstanding paragraph (c)(2)(i) of this section, a plan may
require the notice described in paragraph (a)(4) of this section to be
furnished before the end of the first 18 months of continuation
coverage.
(3) Time limits for notice of change in disability status. The
period of time for furnishing the notice described in paragraph (a)(5)
of this section may not end before the date that is 30 days after the
later of:
(i) The date of the final determination by the Social Security
Administration, under title II or XVI of the SSA, that the qualified
beneficiary is no longer disabled; or
(ii) The date on which the qualified beneficiary is informed,
through the furnishing of the plan's summary plan description or the
notice described in Sec. 2590.606-1, of both the responsibility to
provide the notice and the plan's procedures for providing such notice
to the administrator.
(d) Required contents of notice. (1) A plan may establish reasonable
requirements for the content of any notice described in this section,
provided that a plan may not deem a notice to have been provided
untimely if such notice, although not containing all of the information
required by the plan, is provided within the time limit established
under the plan in conformity with paragraph (c) of this section, and the
administrator is able to determine from such notice the plan, the
covered employee and qualified beneficiary(ies), the qualifying event or
disability, and the date on which the qualifying event (if any)
occurred.
(2) An administrator may require a notice that does not contain all
of the information required by the plan to be supplemented with the
additional information necessary to meet the plan's reasonable content
requirements for such notice in order for the notice to be deemed to
have been provided in accordance with this section.
(e) Who may provide notice. With respect to each of the notice
requirements of this section, any individual who is either the covered
employee, a qualified beneficiary with respect to the qualifying event,
or any representative acting on behalf of the covered employee or
qualified beneficiary may provide the notice, and the provision of
notice by one individual shall satisfy any responsibility to provide
notice on behalf of all related qualified beneficiaries with respect to
the qualifying event.
(f) Plan provisions. To the extent that a plan provides a covered
employee or qualified beneficiary a period of time longer than that
specified in this section to provide notice to the administrator, the
terms of the plan shall govern the time frame for such notice.
(g) Additional rights to continuation coverage. Nothing in this
section shall
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be construed to preclude a plan from providing, in accordance with its
terms, continuation coverage to a qualified beneficiary although a
notice requirement of this section was not satisfied.
(h) Applicability. This section shall apply to any notice obligation
described in this section that arises on or after the first day of the
first plan year beginning on or after November 26, 2004.
[69 FR 30097, May 26, 2004] 
