- More Guidance on Summaries of Benefits and Coverage (SBCs)
- April 23, 2012 | Authors: Anthony C. Ciriaco; Jennifer B. Dunsizer; Jolie N. Havens; Linda R. Mendel; Amy M. Stuckey Swank
- Law Firm: Vorys, Sater, Seymour and Pease LLP - Columbus Office
DOL FAQs (available at http://www.dol.gov/ebsa/faqs/faq-aca8.html) clarify some open issues with respect to SBCs.
To reduce the number of SBCs provided to employees:
- You do not need to provide a separate SBC for each family configuration. You may present all tiers of coverage (e.g., employee-only, employee plus one, family) on a single SBC.
- If two or more benefit packages are identical other than the levels of deductible, copayments and/or coinsurance, you may present the packages on a single SBC provided you can do so in a way that is understandable.
- The SBC for a medical plan may include information on FSAs, HRAs, HSAs, and/or wellness programs that impact cost sharing.
The DOL also clarified the timing of SBCs related to annual open enrollment:
- If you provide employees the opportunity to change benefit elections during an annual open enrollment period (as is common), SBCs should be distributed with open enrollment materials.
- If you do not hold annual open enrollment for a plan (e.g., employees cannot change coverage elections absent a special enrollment event or change in status), SBCs should be distributed at least 30 days before the first day of each plan year.
If you have employees in one of the counties where 10% or more of the population is literate in only the same non-English language, your SBCs will need to include a notice of the availability of language services and foreign language SBCs must be available upon request.
- A list of counties where 10% or more of the population is literate in only the same non-English language is available at http://www.cciio.cms.gov/resources/factsheets/clas-data.html. Currently, no Ohio counties are on the list.
- You may use the same sample notice of the availability of language services that the DOL published for explanations of benefits (EOBs), available at http://www.dol.gov/ebsa/IABDModelNotice2.doc.
- HHS intends to publish foreign language SBC templates which, when available, will be posted at http://cciio.cms.gov/programs/consumer/summaryandglossary/index.html.