Summary Benefits & Coverage (SBC) Required Updates

Summary Benefits & Coverage (SBC) Required Updates

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On Nov. 8, 2019, the Department of Labor (DOL) and Health and Human Services (HHS) issued an updated template and related materials for the summary of benefits and coverage (SBC). These materials are required to be used for plan years beginning on or after Jan. 1, 2021.

Employers need to be aware of these updates now as the updated template must be used for the 2021 plan year’s open enrollment period, which, of course, occurs in 2020. Becoming informed now will enable your team to plan for a smooth open enrollment.

The SBC is just one of many open enrollment notices you need to provide to employees in order to stay compliant and avoid costly penalties and administrative burdens. You can find a list of the other notices here.

SBC Overview

  • The SBC is a concise document providing information about health plan coverage and costs.
  • The SBC requirement applies to group health plans and health insurance issuers.
  • The updated template and related materials must be used for plan years beginning on or after Jan. 1, 2021.

Summary of Updated SBC Materials

  • SBC Template
  • Uniform Glossary
    1. List of anchors for SBC Uniform Glossary terms on www.HealthCare.gov/sbc-glossary/ 
  • Sample Completed SBC
    1. AI/AN Zero Cost Sharing
    2. AI/AN Limited Cost Sharing
  • Instructions for Completing the SBC
    1. Group Health Plan Coverage
    2. Individual Health Insurance Coverage
  • “Why This Matters” language for SBC
    1. “Yes” Answers
    2. “No” Answers
  • Guide for Coverage Examples Calculations
    1. Maternity Scenario—Calculator and Narrative
    2. Diabetes Scenario—Calculator and Narrative
    3. Simple Foot Fracture Scenario—Calculator and Narrative
  • Coverage Examples Calculator (Oct. 2019 revision, for use on and after Jan. 1, 2021)
    1. Instructions
    2. Crosswalk of Changes (describes updates made to the Oct. 2019 version of the Coverage Examples Calculator)

Background of Summary Benefits and Coverage

The Affordable Care Act (ACA) requires both grandfathered and non-grandfathered health plans and health insurance issuers to provide an SBC to applicants and enrollees free of charge. The SBC must be produced in accordance with the applicable template. Form language and formatting must be precisely reproduced, unless instructions allow or instruct otherwise. Unless otherwise instructed, the plan or issuer must use 12-point font (as required by federal law) and must replicate all symbols, formatting, bolding and shading.

The DOL and HHS issued the updated SBC template and related materials on Nov. 8, 2019. Plans must start using the new template beginning on the first day of the first open enrollment period for any plan years (or, in the individual market, policy years) that begin on or after Jan. 1, 2021, with respect to coverage for plan or policy years beginning on or after that date.

Beyond the SBC and other required notices, there’s a lot to manage when it comes to open enrollment. Now is the perfect time to evaluate the effectiveness of your open enrollment systems and identify what drives efficiency. Complete the scorecard on page 5 of this guide to find the areas in which you need to improve in order to achieve open enrollment success.

Summary Benefits & Coverage (SBC) Required Updates~/Portals/0/PackFlashItemImages/WebReady/Informed Open Enrollment.pnghttps://www.cbiz.com/Portals/0/liquidImages/WebReady/Informed Open Enrollment.pngWith new updates provided by the Department of Labor and Health and Human Services for summary of benefits and coverage, compliance is key! Get details on the new updates for the plan year beginning Jan. 1, 2021....2020-01-02T19:19:00-05:00

With new updates provided by the Department of Labor and Health and Human Services for summary of benefits and coverage, compliance is key! Get details on the new updates for the plan year beginning Jan. 1, 2021.

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