Proposed changes to the summary of benefits and coverage

Posted February 13, 2015 Industry Insights, Expert Tips, Company News

Regulations to modify the Summary of Benefits and Coverage (SBC) requirements have been proposed by the IRS, DOL, and HHS. The proposed changes, which are intended to apply to plan years beginning September 1, 2015, include revisions to the SBC template, instructions, and uniform glossary and are intended to clarify the current regulations and make compliance easier for insurers and group health plans.

The proposed regulations would clarify:

SBCs provided prior to application or enrollment

If an SBC is given prior application or enrollment in a plan, a new SBC would not be required unless the information has changed since the first one was provided.

Increased access to policies and certifications

While insurers would be required to include an Internet address where a copy of the individual coverage policy or group certification could be obtained, this would not apply to self-insured group health plans.

The proposed regulations would formalize prior guidance on:

Allocating Contractual Responsibility

An entity may fulfill an SBC obligation by entering into a binding contractual agreement for a third party to provide the SBC, if:

  • The entity monitors the performance of the third party
  • Any errors found are corrected
  • Participants and beneficiaries are notified of any error that cannot be corrected immediately, and “significant steps” are taken to avoid future violations

Exclusions from the SBC requirement

Medicare Advantage plans do not need to be included in the SBC.

Distribution methods

Group health plans with two or more benefit packages may provide single or multiple SBCs.
SBCs may be provided electronically at the time of online enrollment or request. However, the SBC must be provided as a hard copy if requested.


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Please note that the information contained in this document is designed to provide authoritative and accurate information, in regard to the subject matter covered. However, it is not provided as legal or tax advice and no representation is made as to the sufficiency for your specific company’s needs. This document should be reviewed by your legal counsel or tax consultant before use.

Additionally, the messages and content within the Pittsburgh Health Care Reform group do not reflect the advisory services of Henderson Brothers, Inc.