Opt-out Election for Self-funded, Non-federal Governmental Plans
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Sponsors of self-funded, non-federal governmental plans may opt out of complying with certain benefit mandates, such as the coverage mandates for minimum hospital stays for newborns and mothers and reconstructive surgery following mastectomies.
The Department of Health and Human Services (HHS) has provided procedures and model election materials for sponsors of self-funded, non-federal governmental plans to use to opt out of certain federal benefit mandates.
If a plan sponsor decides to opt out of compliance with one or more of the federal benefit mandates, it must notify HHS of its election. This opt-out election must be submitted electronically. Also, the plan must provide a notice to enrollees regarding the election. The notice must be provided annually and at the time of enrollment. HHS has provided a model notice that employers may use.
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