The following procedures and requirements apply with respect to a plan sponsor's election to exempt its group health plan from requirements of Title XXVII of the Public Health Service Act:

• An exemption for a self-funded non federal governmental plan is not automatic.  If the sponsor of a self-funded non federal governmental plan wishes to exempt its plan from one or more requirements of Title XXVII, it must notify the Centers for Medicare & Medicaid Services (CMS) to that effect in writing. (See Model Exemption Election Letter in related download at bottom of page. Use of model format is not required, but requested information must be provided to CMS.)
• An election to opt-out of one or more of the requirements of Title XXVII of the PHS Act may be sent to CMS at the following address:
       Centers for Medicare & Medicaid Services
       Medicare Enrollment and Appeals Group, CPC
       ATTN: HIPAA Opt-Out
       7500 Security Boulevard
       C2-12-16
       Baltimore, MD 21244-1850
       or via facsimile to 410-786-8001
• An election applies for a single specified plan year, or, in the case of a plan provided pursuant to a collective bargaining agreement, for all plan years encompassed by the agreement.
• A plan sponsor may renew an opt-out election for a subsequent plan year (or period of plan coverage) by notifying CMS in writing. (See Model Exemption Election Letter in related download at bottom of page. Use of model format is not required, but requested information must be provided to CMS.) 
• Under an opt-out election, the plan must provide for: (1) notice to enrollees, on an annual basis* and at the time of enrollment under the plan, of the fact and consequences of the election (see Model Notice to Enrollees in related download at bottom of page (use of model format is not required); and (2) certification and disclosure of an individual's creditable coverage under the plan.

*IMPORTANT: The annual notice to plan enrollees generally must be disseminated BEFORE the plan year begins for a plan's initial exemption election and, in the case of an exemption election renewal, for any Title XXVII requirement from which the plan is to be exempted but from which the plan was not exempt during the immediately preceding plan year. (See regulations at 45 CFR 146.180(f)(2) and (g)(3) in related download at bottom of page.)

• A copy of the enrollee notice should be attached to the initial exemption election letter that is submitted to CMS.

Downloads
Model HIPAA Exemption Election/Election Renewal Document (PDF, 59KB) Model Notice to Enrollees in a Self-Funded Non-Federal Governmental Group Health Plan (PDF, 66KB) Regulations (45 CFR 146.180) [ZIPPED PDF, 126KB]
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Page Last Modified: 11/17/2008 3:24:38 PM
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