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(SBC) Summary of Benefits and Coverage for 2014

May 1, 2013 by admin Leave a Comment

New Summary of Benefits and   Coverage Template for 2014

Employers responsible for   distributing a summary of benefits and coverage (SBC) to employees in   connection with group health plan coverage will need to include additional   language to satisfy new requirements under Health Care Reform becoming   effective in 2014. An updated SBC template, which includes the new language,   is now available for SBCs provided with respect to coverage beginning on   or after January 1, 2014 and before January 1, 2015.

SBC Notice Requirements
Group health plans are required to provide, without charge, a standard SBC   form explaining plan coverage and costs to employees at specified times   during the enrollment process and upon request. For insured group health   plans, the notice requirement may be satisfied if the issuer furnishes   recipients with a timely and complete SBC.

New Language Required for 2014

The updated SBC template includes   additional language indicating whether the plan provides “minimum   essential coverage” (the type of coverage an individual needs to satisfy   the individual responsibility requirement), and   whether the plan meets the “minimum value” standard under Health   Care Reform (meaning the plan pays for at least 60% of covered health care   expenses).

FAQs issued simultaneously provide some relief for plans   already working on preparing SBCs for 2014, where adding the new information   to the template would present an administrative burden. To the extent a plan   is unable to modify the SBC template for coverage beginning on or after   January 1, 2014 and before January 1, 2015, a plan may use the previously   authorized template, so long as the SBC is furnished with a cover   letter or similar disclosure stating whether the plan does or does not   provide “minimum essential coverage” and “minimum value.”

Filed Under: News and Compliance

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