Human Resources News & Insights

New health summary FAQ: 5 things you need to know

A new FAQ regarding health reform’s Summary of Benefits and Coverage (SBC) mandate clears up some of the finer points about the requirement.

The reform law says employers who sponsor health plans must provide workers with “summaries of coverage.”

And the final rules state that insurance companies and plan sponsors with plan years that start September 23, 2012 or later will have to supply the documents during their next open enrollment. (Here’s our previous breakdown on what’s required.)

Here are the highlights of the recent FAQ issued by the feds:

  • Instead of having to distribute an SBC for all the various coverage options — employee-only, employee-plus-spouse, and family — one document will suffice. But when info on multiple coverage options is included in a single SBC, the coverage example used must be for employee-only coverage.
  • When a plan sponsor has contracted a vendor to provide SBCs to workers, the plan sponsor will not be subject to penalties by the vendor as long as the sponsor monitors the vendor’s efforts, corrects problems and notifies workers of any problems.
  • SBCs must be distributed during initial enrollment for new hires and open enrollment. They must also be distributed if there are any plan changes required to be documented by an SBC, if a worker requests one and when written application materials (any forms or requests for information that must be completed prior to enrollment) are distributed.
  • COBRA-qualified beneficiaries must be sent an SBC.
  • Minor adjustments can be made to the SBC format the feds provided.

Info: Click here to view the latest FAQ issued by the Treasury, the Department of Labor and the Department of Health and Human Services.

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