Are you gearing up for open enrollment’s alphabet soup? Anyone who works in human resources/employee benefits and has survived even one open enrollment season knows just how busy that alphabet soup will make your next few months.
Before open enrollment is in full swing and things get too crazy, you should spend some time reviewing the disclosures you will use. Even if you have a TPA who generally takes responsibility for open enrollment, the ultimate responsibility for legal compliance belongs to the plan administrator.
In particular, this year there have been some major changes to the Summary of Benefits and Coverage (“SBC”). The new SBC requirements apply to all group health plans for plan years beginning on or after April 1, 2017. You should confirm that your SBC has been updated to satisfy the new requirements. Among other changes, you’ll notice that a new introductory paragraph has been added; certain questions have been eliminated, added (e.g., are there services covered before you meet your deductible?), or rephrased; and, a third coverage example has been added. Because the changes to the SBC are quite extensive this year, we recommend that you undertake a wholesale review of your SBC.
Here are a few quick tips to help you review your SBC:
- Compare your SBC to the DOL’s template SBC: There’s a template available for your use at https://www.dol.gov/sites/default/files/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/sbc-template-final.pdf. We recommend using this template if you provide SBCs electronically because there are imbedded hyperlinks for each defined term that take participants directly to that exact term in healthcare.gov’s uniform glossary. If you don’t provide SBCs electronically, you will still need to reference the uniform glossary’s web address (https://www.healthcare.gov/sbc-glossary/) at the top of the SBC.
- Tips for Comparison on Form: When comparing your SBC to the template, here are some quick things to check:
- Is the SBC no more than four doubled-sided pages;
- Are all defined terms underlined; and
- Are no rows or columns deleted?
- How to Compare for Substance: The Department of Labor has provided an instruction guide which includes detailed language and guidance for situations which may not be standard: https://www.dol.gov/sites/default/files/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/sbc-instructions-for-completing-the-individual-health-insurance-coverage-final.pdf. You should verify that the detailed SBC language requirements are satisfied (both what to say and what not to say).
Our final word of advice: find time to review your SBCs now before your alphabet soup starts to boil (or call your friendly outside counsel for help)!