H&W: Summary of Benefits and Coverage FAQs

Summary of Benefits and CoverageSummary of Benefits and Coverage: On May 11,2012, the Departments of Labor, Treasury and HHS (“the Departments”) issued an Frequently Asked Questions (FAQs) regarding the obligation of health plans and insurers to provide a summary of benefits and coverage (SBC). Here are some highlights from those FAQs.

· SBCs can be provided electronically to plan participants in connection with their online enrollment or renewal of coverage under the plan. This expands on the scope of acceptable means to deliver SBCs electronically.

· Other documents can be referenced in an SBC (e.g., a summary plan description) but references can’t be used as a substitute for required SBC content.

· The Departments are developing a calculator that plans and insurers can use as a safe harbor during the first year of applicability to complete the coverage examples required for an SBC. That calculator will be available at the Centers for Medicare and Medicaid Services (CMS) web site.

· Translations of the SBC template are available in Spanish, Chinese and Tagalog at the CMS web site.

· An entity that fails to provide a required SBC is subject to a fine. However, during the first year of applicability, the Departments will not impose a fine on plans and insurers that are working diligently and in good faith to comply.

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