Rule Changes for Health Plan SBCs Apply September 2015

On June 16, 2015, the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively “the Departments”) finalized Rules for the delivery of Summaries of Benefits and Coverage (SBCs). These rules do not affect the SBC template and uniform glossary; changes in those items will be addressed in future rules for late 2016 and 2017. In the meantime, however, the final rules on delivering SBCs generally apply to group health plans for enrollment periods beginning on or after September 1, 2015.

The SBC is a standardized benefit summary, sometimes referred to as the “uniform four-page summary” (although it may be up to eight pages due to double-siding), that is designed to help consumers compare plans. The Departments provide templates and instructions that insurers and plan sponsors (employers) use to create their plan-specific SBCs. For details about the current templates, see webpage.

The Departments also provide rules on the timing and delivery of SBCs. Generally, SBCs must be distributed to eligible participants at enrollment, within seven days of a participant’s request, and within 90 days of a special enrollment (e.g., due to marriage, or birth or adoption of a child). The final June 2015 rules adopt the following changes or clarifications regarding delivery of the SBC:

  • If an SBC was provided before the participant was eligible to enroll, the SBC is not required to be provided again automatically as long the SBC information has not changed.
  • The entity responsible for providing the SBC may enter into a binding contract for another party to provide the SBC if certain conditions are met. For instance, a self-funded employer may contract with a vendor to provide the SBC if:
    • The employer monitors the vendor’s performance; and
    • The employer corrects any noncompliance determined to have occurred.

If the employer does not have the information needed to correct the noncompliance, the employer must communicate with the plan’s participants and beneficiaries about the noncompliance and take significant steps to avoid future violations.

  • A group health plan with multiple benefit packages may provide either a single or multiple SBCs.
  • The SBC may be provided electronically in connection with online enrollment or in response to an online request (but it must be provided in paper form if requested).
  • The SBC must include contact information for questions. Insurers also must include an Internet web address for participants to review and obtain a copy of the policy or certificate of coverage.

The above clarifications take effect for group health plans for enrollment periods beginning on or after September 1, 2015. Insurers and employers are advised to review their procedures for delivering SBCs to ensure compliance with the new rules.

The Departments also are working on proposed rule changes that will affect the SBC template, such as reducing the amount of required information, shortening the template from four to two-and-a-half double-sided pages, and adding another coverage example. The Departments expect to finalize the template and related instructions by January 1, 2016 to take effect fall 2016 (for coverage beginning on or after January 1, 2017). The Departments are using the extra time to conduct consumer testing and gather input from the public, including the National Association of Insurance Commissioners, before finalizing changes to the SBC template.

About Laura Kerekes, SPHR, SHRM-SCP

Laura Kerekes is ThinkHR’s Chief Knowledge Officer and leads the company’s human resources knowledge operations teams. She provides expertise to customers with complicated human resources and management issues, offers knowledge and guidance regarding management and HR best practices, and regularly shares her expertise through articles and webinars.