Insurance carriers and group health plans (including self-insured employer plans), must provide a Summary of Benefits and Coverage (SBC) to all participants and beneficiaries who enroll or re-enroll in group health coverage through open enrollment periods beginning on or after September 23, 2012. There are steep fines applied to those who fail to comply, ranging from $100 to $1000 per employee. Full compliance includes meeting rigorous guildelines regarding:
Formatting: The SBC can be \”provided either as a stand-alone document or in combination with other summary materials. For health insurance coverage provided in the individual market, the SBC must be provided as a stand-al;one document.
Non-English Language Requirements: The SBC must be supplied in a culturally and linguistically appropriate manner when 10 percent or more of the population residing in a county are literate only in the same non-English language, as determines based on American Community Survey data published by the United States Census Bureau.
Special Rule: Group health plans and health insurance issuers must use the full, authorized SBC template even during this first year of the new law\’s applicability.
Uniform Glossary: The plan issuers must also deliver a Uniform Glossary of healthcare terms to make it easier for plan participants to understand the language used in the SBC and other plan documents.
The SBC must be provided to a plan participant on several instances:
- Upon application
- By first day of coverage (if there are any changes)
- Special enrollees
- Upon renewal
- Upon request (no later than seven days from receipt of request)
For more details, please refer to the three FAQ documents published on the DOL website
