Summary of Benefits and Coverage (SBC) Information

Most have been prepared for the Health Reform SBC mandates related to their fully insured health plan.  However, Health Reform also states that SBCs are required for all group health plans, including HRAs.  This provision starts with the first open enrollment period beginning on or after September 23, 2012 – basically October 1st and beyond.

Because the SBC guidelines were written for fully-insured health plans, they are confusing when applied to HRAs.  The HHS has suggested that when applying the SBC to HRAs, a good faith effort should be made to comply while following the instructions to the extent possible.

I would anticipate that there will be multiple SBCs distributed – particularly when last minute plan changes and/or carrier changes are made.  This will be something employers should continually communicate with employees about what is happening and why.

As a reminder, employers will need to distribute the SBC to their employees:

  • Prior to open enrollment or renewal (at least 30 days)
  • When first eligible for initial enrollment
  • If there is a mid-year qualifying event
  • If there is a plan change
  • Upon request (within 7 business days from the request.)

We are providing clients with SBC assistance – bridging the gap between administrators and carriers – interpreting the regulatory instructions. As we cannot provide legal advice, we advise our clients to have this document reviewed by legal counsel. As always, we are available to assist you with any questions you may have.


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