Get the free Notice of Coverage Options FAQsU.S. Department of Labor
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New Health Insurance Marketplace Coverage
Options and Your Health CoverageForm Approved
OMB No. 12100149
(expires 5312020)PART A: General Information
When key parts of the health care law take effect
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How to fill out notice of coverage options
How to fill out notice of coverage options
01
To fill out the notice of coverage options, follow these steps:
02
Begin by entering the name of the employee or individual for whom the notice is being completed.
03
Provide the employee's mailing address and contact information.
04
Specify the date on which the notice is being completed.
05
Next, select the appropriate coverage option from the available choices and indicate whether it applies to single coverage, family coverage, or both.
06
If the coverage option is not applicable, indicate that the employee is not eligible for coverage.
07
Include any additional information or instructions that may be helpful for the recipient of the notice.
08
Ensure that all the information provided is accurate and up-to-date.
09
Review the completed notice for any errors or missing details before submitting it.
Who needs notice of coverage options?
01
The notice of coverage options is required for employers who are subject to the Affordable Care Act (ACA).
02
This notice needs to be provided to all employees, regardless of their enrollment status in the employer's health insurance plan.
03
It is also required for employees who are not eligible for coverage under the employer's plan.
04
Essentially, any employer subject to the ACA must provide this notice to all employees.
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