New Version Summary of Benefits and Coverage (SBC) Effective April 1, 2017

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As reminder, the new version of the SBC, uniform glossary, and related documents are required for use on or after April 1, 2017. As required by the Affordable Care Act (ACA), group health plans and health insurance issuers are generally required to provide a written SBC to all eligible individuals and beneficiaries at initial enrollment, open enrollment, special enrollment and upon request.

The new SBC template includes an additional coverage example as well as language and terms to improve individuals' understanding of their health coverage. The updated template improves readability and includes more information about cost sharing, enhanced language to explain deductibles, and requires plans to address individual and overall out-of-pocket limits.

According the Summary of Benefits and Coverage Instruction Guide for Group Coverage, the new version of the SBC must be distributed to all eligible individuals and beneficiaries as follows:

  • Health plans and issuers that maintain an annual open enrollment period will be required to use the new editions beginning on the first day of the first open enrollment period that begins on or after April 1, 2017 with respect to coverage for plan years beginning on or after that date. As applicable, this will be required for the group medical plan, Health Reimbursement Arrangement (HRA) and/or non-excepted Health Flexible Spending Accounts.
  • Health plans and issuers that do not use an annual open enrollment period will be required to use the new editions beginning on the first day of the first plan year that begins on or after April 1, 2017. As applicable this will be required for the group medical plan, Health Reimbursement Arrangement (HRA) and/or non-excepted Health Flexible Spending Accounts.

Employee Benefits Corporation will make the new template available in the employer portal this week for employers that have the EBC HRA.

See a previous Compliance Buzz for rules on electronic distribution.  See a previous Compliance Buzz for more information on the Summary of Benefits and Coverage.

Click here to access the new SBC template and related materials from the U.S. Department of Labor.

Categories: Health Care Reform, Compliance, Health Care in General | Tags: SBC , HRA , ACA | Return