For participants and beneficiaries who enroll or re-enroll through an open enrollment period (including late enrollees and re-enrollees), the SBC must be provided beginning on the first day of the first open enrollment period that begins on or after September 23, 2012.
For participants and beneficiaries who enroll in coverage other than through an open enrollment period (including individuals who are newly eligible for coverage and special enrollees), the SBC must be provided beginning on the first day of the first plan year that begins on or after September 23, 2012.
The final regulations require that the SBC be provided in several instances:
A group health plan must provide notice of a material modification if it makes a material modification in any of the terms of the plan that is not reflected in the most recently provided SBC.
Only material modifications that would affect the content required in the SBC would require plans to provide this notice. In these circumstances, the notice must be provided no later than 60 days prior to the date on which such change will become effective, if it is not reflected in the most recent SBC provided and occurs other than in connection with a renewal (i.e., mid-plan year).
This requirement for an advance notification could be satisfied either by a separate notice describing the material modification or by providing an updated SBC reflecting the modification. It would be RCI’s recommendation to just update your current SBC and distribute a new one.
A material modification includes any modification to the coverage offered under a plan that, independently, or in conjunction with other contemporaneous modifications or changes, would be considered by an average plan participant to be an important change in covered benefits or other terms of coverage under the plan.
A material modification could be an enhancement of covered benefits or services or other more generous plan terms.
A material modification could also be a material reduction in covered services or benefits or more stringent requirements for receipt of benefits. As a result, it also includes changes or modifications that reduce or eliminate benefits, increase premiums and cost-sharing, or impose a new referral requirement.
If your plan offers multiple benefit options, you are only required to provide the SBC for the plan option which the participant or beneficiary is already enrolled in; SBC’s are not required to be provided with respect to plan options the participant or beneficiary are not enrolled in. However, if the participant or beneficiary requests an SBC for another plan options for which they are eligible for, the SBC must be provided (e.g. sent) as soon as practicable, but no later than 7 business days following the request.
The SBC may be provided in paper form or electronically.
Those regulations include a safe harbor for disclosure through electronic media to participants who have the ability to effectively access documents furnished in electronic form at any location where the participant is reasonably expected to perform duties as an employee and with respect to whom access to the employer's electronic information system is an integral part of those duties.
The Departments have provided the following sample language for postcards and e-cards that can be modified:
As an employee, the health benefits available to you represent a significant component of your compensation package. They also provide important protection for you and your family in the case of illness or injury.
Your plan offers a series of health coverage options. Choosing a health coverage option is an important decision. To help you make an informed choice, your plan makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about any health coverage option in a standard format, to help you compare across options.
The SBC is available on the web at: www.website.com/SBC. A paper copy is also available, free of charge, by calling 1-XXX-XXX-XXXX (a toll-free number).
Yes. You have the same distribution requirements for COBRA participants as you do for active participants.
The information provided in this document is provided for informational purposes only, is not all inclusive and is not intended to advise your Plan how it may comply with any provisions of the referenced legislation or related legislation or regulations, nor it is otherwise intended to impart any legal advice. If you have any questions about how to comply with this or any other law or regulation, we recommend that you consult with your attorney.