Summary of Benefits & Coverage
A group health plan (and its administrator) must provide a summary of benefits and coverage (SBC) for each benefit package free of charge to entities and individuals for open enrollment periods starting on or after Sept. 23, 2012. The plan must provide the SBC as part of any written application materials it distributes for enrollment.If the plan doesn’t distribute written application materials for enrollment, it must distribute the SBC no later than the first date on which the participant is eligible to enroll in coverage for the participant or any beneficiaries. If there’s any change to the information required to be in the SBC that was provided on application and before the first day of coverage, the plan must update and provide a current SBC to a participant or beneficiary no later than the first day of coverage. Among the items to be included in the SBC are:
- A uniform glossary of definitions of standard insurance terms and medical terms so that consumers may compare health coverage and understand the terms of (or exceptions to) their coverage,
- A description of the coverage, including cost sharing, for each category of benefits identified by the secretary in guidance,
- The exceptions, reductions and limitations of the coverage,
- The cost-sharing provisions of the coverage, including deductible, coinsurance and copayment obligations, and
- The renewability and continuation of coverage provisions.
If you have questions or need additional copies of your group’s SBC, please contact us.