Under Health Care Reform, insurers and plan sponsors must distribute a Summary of Benefits and Coverage (SBC) to plan participants each year. The SBC requirement was not overturned as part of the U.S. House of Representatives ACA replacement bill.
Last year the U.S. departments for implementing health care reform changed the ACA template. The new template must be used starting with the first open enrollment period beginning on or after April 1, 2017. Plan sponsors must distribute the SBC 30 days before the start of a plan year. That means plans with a July 1 effective date should be working on updating their SBCs now.
Changes to the SBC include
- Revising some questions on Page 1;
- New answers in the Why This Matters section;
- Specific details in the Common Medical Events Section;
- Changes in the cost data for the coverage examples;
- New coverage examples (fracture treated in an emergency room);
- New nondiscrimination notice;
- Information on how to get assistance in the 15 most prevalent langauges in the area;
Failing to provide a SBC can result in significant penalties, including a fine of over $1000 per participant who does not receive a proper SBC.
A copy of the updated template can be accessed here.
Plan Sponsors should make sure they update their SBC in accordance with the new requirements and should begin preparations now.
