Administration

The Affordable Care Act is presenting employers with new challenges in managing benefit plans. The information in this section will help you stay informed about how to adequately administer your plans.

Uniform Summary of Benefits and Coverage

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Effective September 23, 2012, plan sponsors and health insurance issuers must provide a Summary of Benefits and Coverage (SBC) to all participants and beneficiaries at the beginning of each new plan year, when enrolling in coverage for the first time or within seven business days if a copy is requested.

The standardized SBC is designed to inform participants about the benefits and coverage under the plan in a format that makes it easy to understand.  In addition, issuers and plan sponsors must provide a uniform glossary of commonly used health insurance terms upon request.

The aim of these requirements is to help consumers better understand the features of their health plans so that they can compare options and make informed decisions on which plan best meets their needs.

Notice of Material Modification

Issuers and plan sponsors must provide a notice of material modification to plan participants if they make material changes mid-year to any terms of the plan that are not reflected in the most recent SBC.  The notice must be provided to plan participants at least 60 days before the changes become effective.  Material modifications include, but are not limited to, benefit reductions or increases in cost sharing.

 

Additional Information
Health Care Reform: New Summary of Benefits and Coverage Template Finalized
On April 6, 2016, the Departments of Health and Human Services, Labor and the Treasury released updated versions of the SBC template and its associated documents.
Health Care Reform: Q&A On Final SBC Requirements
The final regulations regarding Summary of Benefits and Coverage (SBC) requirements under the Affordable Care Act have been released. This Briefing summarizes those regulations.