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Summaries of Benefits and Coverage (SBCs)

Summaries of Benefits and Coverage (SBCs). Laura Dillon Senior Manager, Insurance Marketing. Today’s Agenda. What are Summaries of Benefits and Coverage (SBCs)? Why am I receiving SBCs? What is my responsibility as an employer? When do the rules go into effect? What does an SBC look like?

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Summaries of Benefits and Coverage (SBCs)

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  1. Summaries of Benefits and Coverage (SBCs) Laura DillonSenior Manager, Insurance Marketing

  2. Today’s Agenda • What are Summaries of Benefits and Coverage (SBCs)? • Why am I receiving SBCs? • What is my responsibility as an employer? • When do the rules go into effect? • What does an SBC look like? • Where can I access SBCs? • Who can I talk to if I need help? • Questions and answers

  3. What Are Summaries of Benefits and Coverage (SBCs)?

  4. Overview of SBCs • A provision of the healthcare reform law requires group health plans to provide SBCs for the plan year beginning on or after September 23, 2012. • The SBCs are designed to be summaries describing a health plan’s benefits and coverage. • Purpose of the SBC is to allow consumers to use SBCs as they compare insurance benefits and options apples-to-apples. • All insurance companies and self-funded plans must follow the federal government SBC template with no deviation.

  5. Important Elements • SBCs include important information: • The benefits covered and what a participant pays, including deductibles and co-pays • Answers to important questions a consumer would ask about a plan • Common medical events and services a consumer may need • Other covered services and excluded services • A consumer’s rights to continue coverage • Claims appeals information • Coverage examples: • Having a baby • Managing type 2 diabetes

  6. Why Am I Receiving SBCs?

  7. You Need to Take Action • If you have medical coverage with GuideStone: • GuideStone will provide employers with SBCs for the health plans they offer. • If you have a Health Reimbursement Arrangement (HRA) with The Employee Benefits Corporation (EBC): • EBC or your HRA administrator will provide SBCs for your HRA. • Employers must provide SBCs to employees and their dependents.

  8. You Need to Take Action • Make sure you comply! • Failure to provide SBCs can result in a fine up to $1,000 per enrollee. • The government has extended leniency toward penalty enforcement in 2013, but compliance is still the best course of action.

  9. We Will ProvideSBCs for You • GuideStone has created SBCs according to healthcare reform regulations. • We have provided SBCs for you: • In your annual renewal binder. • On Employer Access. • Online at www.GuideStone.org/Summaries. • Through your GuideStone representative. • As updates or changes are made to SBCs, we will provide SBCs to you ahead of any deadlines.

  10. What Is my Responsibilityas an Employer?

  11. Distribute SBCsto All Employees • An employer must distribute SBCs to all eligible employees, including: • Employees who have waived out of medical coverage. • Enrolled employees. • Newly hired employees. • Employees with qualifying events: • E.g., a newborn or marriage requires you distribute an SBC. • You are not required to provide multiple copies to one family at the same address.

  12. When to Distribute SBCs

  13. How to Distribute SBCs • Print in grayscale or Department of Labor (DOL) blue, if you've downloaded online versions. • Copy double-sided (front and back). • Provide printed copies directly to employees. Placing SBCs in a common area is not permissible. • If an employee requests an SBC electronically, you may provide it electronically with the language you will find on slide 15. Otherwise, you must follow DOL rules for electronic delivery.

  14. DOL Criteria for Electronic Copies • You must meet the criteria below to distribute SBCs electronically to an employee. If any of the criteria below is not met for an employee, you must provide that employee with printed copies of SBCs. • Your employee must use your email system as an integral part of his or her job to be eligible to receive electronic copies. • If an employee does not use your email system as an integral part of his or her job, he or she is not eligible to receive electronic copies and you must provide printed copies. • Your email system must confirm emails withdelivery receipts. Continued on next slide

  15. DOL Criteria for Electronic Copies, Continued • You must protect employees’ confidentiality by restricting access to emails. • You are not allowed to change the DOL-mandated format of the SBC. • You must forward the SBC with a statement that explains the SBC’s significance and the employee’s right to a paper copy. You may use the statement below. “The Summary of Benefits and Coverage was created to help consumers more easily compare plans and understand their insurance benefits. You may also request a printed copy at any time.” For specific DOL criteria and rules, please read the Department of Labor’s publication29 CFR 2520.104b-1 or visit www.dol.gov/ebsa/regs/fedreg/final/2002008499.pdf.

  16. Timeline for Distributing SBCs 23 12 1

  17. When Do the RulesGo into Effect?

  18. SBC Effective Dates • For employees currently enrolled in a medical plan: • First day of re-enrollment that begins on or after September 23, 2012. • For employees not currently enrolled in a medical plan (newly hired, newly eligible for coverage or special enrollees): • First day of the new plan year that begins on or after September 23, 2012. • GuideStone’s new plan year begins on January 1 for most employers.

  19. What Does an SBC Look Like?

  20. Preview of an SBC Plan name Answers to important questions a consumer would ask about a plan

  21. Preview of an SBC Helpful descriptions Common medical events and services a consumer may need

  22. Preview of an SBC Excluded services More covered services Rights to continue coverage Claims appeals information

  23. Preview of an SBC • Coverage examples: • Having a baby • Managing type 2 diabetes

  24. Where Can I Access SBCs?

  25. Access SBCs • Printed copies: • Examples of the SBCs for the plans you currently offer are in your renewal binder. • Request printed SBCs through your GuideStone representative. • Electronic copies:* • SBCs for your current plans are onEmployer Access. • All SBCs are online at www.GuideStone.org/Summaries. • *DOL rules apply to distributing electronic copies to employees.

  26. Who Can I Talk to if I Need Help?

  27. Contact Information • GuideStone • Call your GuideStone group representative • Email us: Insurance@GuideStone.org • Visit our website: www.GuideStoneInsurance.org • Department of Labor • To read the Summary of Benefits and Coverage regulations, visit www.dol.gov/ebsa/healthreform For up-to-date information on healthcare reform, visit www.GuideStone.org/HealthReform

  28. Questions and Answers

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