Many small employers are unaware that offering group health insurance can trigger certain employee notice requirements under federal and state law.
This page is intended to help Ohio employers with 2–50 employees understand which health insurance notices may apply, the general conditions under which they apply, and where to find authoritative guidance from government agencies.
This resource is informational only. Employers remain responsible for determining which notices apply to their specific situation and for ensuring those notices are provided as required.
How to Use This Page
This page is designed as a reference, not a compliance checklist.
It can help you:
- Understand which employee health insurance notices commonly arise for small employers
- Identify general triggers that may make a notice applicable
- Access official federal and Ohio guidance for further review
In many cases, insurance carriers or administrators include required notices within plan documents or enrollment materials. Employers should confirm how notices are handled for their specific plan design.
Federal Employee Health Insurance Notices That May Apply
The notices below commonly apply to small employers depending on plan design, employer size, or employee circumstances.
Medicare Part D Creditable Coverage Notice
When it may apply:
If your group health plan includes prescription drug coverage.
Who typically provides it:
Employer (often using carrier-provided language).
Official guidance:
- https://www.medicare.gov/basics/forms-publications-mailings/mailings/costs-and-coverage/notice-of-creditable-coverage
- https://www.cms.gov/medicare/employers-plan-sponsors/creditable-coverage
Children’s Health Insurance Program (CHIP) Notice
When it may apply:
If any employee resides in a state that offers Medicaid or CHIP premium assistance.
Who typically provides it:
Employer (carriers often provide model notices).
Official guidance:
Note: Ohio currently does not offer CHIP premium assistance, but this notice may still apply if employees reside in other states.
Women’s Health and Cancer Rights Act (WHCRA) Notice
When it may apply:
If the health plan covers mastectomy benefits.
Who typically provides it:
Often included by the insurance carrier in plan materials.
Official guidance:
HIPAA Special Enrollment Rights Notice
When it may apply:
When employees are first eligible for the health plan or experience certain life events.
Who typically provides it:
Often included in enrollment or plan documents.
Official guidance:
Primary Care Provider (PCP) Patient Protections Notice
When it may apply:
If the health plan requires designation of a primary care provider or referrals (such as certain HMO plans).
Who typically provides it:
Usually included by the insurance carrier in plan documents.
Official guidance:
ADA Wellness Program Notice
When it may apply:
If the employer offers a wellness program that collects health information (such as health questionnaires or biometric screenings).
Who typically provides it:
Employer or wellness program vendor.
Official guidance:
Newborns’ and Mothers’ Health Protection Act (NMHPA) Notice
When it may apply:
If the plan provides maternity or newborn coverage.
Who typically provides it:
Insurance carrier (included in plan documents).
Official guidance:
ACA Exchange (Marketplace) Notice
When it may apply:
For new hires, regardless of employer size, if the employer is subject to the Fair Labor Standards Act.
Who typically provides it:
Employer.
Official guidance:
Individual Coverage HRA (ICHRA) Notice
When it may apply:
If the employer offers an Individual Coverage Health Reimbursement Arrangement (ICHRA) instead of a traditional group health plan, or for a different class of employees.
Who typically provides it:
Employer (often with support from a third-party administrator or ICHRA platform).
Overview:
ICHRA notice requirements are established under federal regulations governing health reimbursement arrangements. Employers offering an ICHRA are required to provide a written notice to eligible employees explaining how the arrangement works and how it affects their eligibility for individual health insurance coverage and federal premium tax credits.
This notice is a central compliance requirement for ICHRAs and is more detailed than most other employee health notices.
Timing requirements:
- Generally must be provided at least 90 days before the start of the plan year
- For new hires or employees who become eligible mid-year:
-Must be provided no later than the date the ICHRA may first take effect
Key information the notice must include:
- The amount of the ICHRA benefit available
- The requirement to enroll in qualifying individual health insurance coverage
- How the ICHRA may affect eligibility for Marketplace (Exchange) premium tax credits
- Instructions for opting out of the ICHRA
- Information about special enrollment periods
- Instructions for reporting the ICHRA to the Marketplace
- Contact information for assistance
(Note: Federal regulations require additional details beyond the items listed above. Many employers use the official model notice to ensure all required elements are included.)
Important consideration:
Employees generally must choose whether to accept or decline the ICHRA. Eligibility for Marketplace premium tax credits depends on whether the ICHRA is considered affordable and whether the employee opts out of the arrangement.
Official guidance:
- U.S. Department of Labor (model notice and rulemaking materials): https://www.dol.gov/agencies/ebsa/laws-and-regulations/rules-and-regulations/completed-rulemaking/1210-ab87/individual-coverage-model-notice
- HealthCare.gov (employer overview):
https://www.healthcare.gov/small-businesses/learn-more/individual-coverage-hra/
COBRA Continuation Coverage (Federal)
When it may apply:
If the employer had 20 or more employees in the prior year.
Who typically provides it:
Employer, often through a COBRA administrator.
Official guidance:
Ohio Continuation Coverage (“Mini-COBRA”) for Small Employers
Employers with fewer than 20 employees are often dealing with Ohio continuation coverage rules rather than federal COBRA, although the operational details can depend on the plan structure and the specific situation involved.
Ohio continuation coverage (sometimes informally called “Ohio mini-COBRA”) is generally associated with continuation rights that may apply after employment ends under certain conditions. However, employers should avoid assuming Ohio continuation works exactly like federal COBRA. Eligibility rules, timing requirements, payment procedures, and plan administration can differ in important ways.
Operational details such as:
- the type of health plan involved
- whether the arrangement is fully insured, level-funded, self-funded, association-based, or part of a MEWA
- coverage end dates
- notice timing
- and continuation payment handling
can all affect how continuation obligations are administered in practice.
The Ohio Department of Insurance explains Ohio continuation coverage primarily from the employee’s perspective, but employers should review the official guidance carefully and confirm procedures with the carrier, administrator, governing plan documents, or legal guidance where appropriate.
Official Ohio guidance:
- https://insurance.ohio.gov/consumers/health/health-insurance-options-in-ohio
- https://insurance.ohio.gov/consumers/health/health-insurance-guide
Additional resource:
Statutory reference (for legal detail):
Important Disclaimer
This page is provided for general informational purposes only and reflects federal and Ohio guidance available as of 1/2026. Health insurance notice requirements may change, and applicability depends on factors such as plan design, employer size, and employee circumstances.
This information is not legal or compliance advice. Employers remain responsible for determining which notices apply to their specific situation and for ensuring that required notices are provided in accordance with applicable law. Employers should consult their insurance carrier, plan administrator, or legal advisor regarding their specific obligations.