An SBC can always be provided in paper form. .usa-footer .grid-container {padding-left: 30px!important;} This rule applies when a plan’s terms that must be included in the SBC cannot be reasonably described consistent with the template and the instructions. If a health plan or issuer makes any material change to the terms of the plan or coverage that is not reflected in the most recent SBC, it must notify enrollees of the change. In this case, the plan or issuer must accurately describe the plan’s terms while using its best efforts to remain consistent with the instructions and template. @media only screen and (min-width: 0px){.agency-nav-container.nav-is-open {overflow-y: unset!important;}} SBCs are only required … Answer YES if you get Aetna coverage through your job or your spouse’s job, or if you have an Aetna Medicare plan. The uniform glossary is a standard document that must be provided in the form that was issued by HHS. These penalties are in addition to other ACA penalties related to insurance market reform rules. Yes. .h1 {font-family:'Merriweather';font-weight:700;}         - Coverage examples. Links to various non-Aetna sites are provided for your convenience only. provide individuals a “summary of benefits and coverage” that “accurately describes the benefits and coverage under the plan.” The SBC is a snapshot of a health plan’s costs, benefits, covered health care services, and other features that are important to consumers. Beginning January 1, 2021, plan sponsors should use the updated Summary of Benefits & Coverage (SBC), and related materials. In these situations, an employer may wish to consider applying the guidance applicable to ‘Newly Eligible’ individuals. Learn how to change your browser settings to enable Javascript. Yes Yes. div#block-eoguidanceviewheader .dol-alerts p {padding: 0;margin: 0;} stream 1 0 obj p.usa-alert__text {margin-bottom:0!important;} The final rule also specifies who should provide the SBC and when, and who should receive it. .dol-alert-status-error .alert-status-container {display:inline;font-size:1.4em;color:#e31c3d;}         - Cost-sharing provisions, such as deductibles, copays and coinsurance At a minimum, ACA requires an SBC to include: - Cost sharing However, this guidance does not appear to take into account employees who waived coverage and who will be enrolling for coverage. >. Do you have Aetna insurance through an employer or are you a Medicare member? In order to have the best experience on, Javascript needs to be enabled. It must use language that the average plan enrollee can understand. Such notice must be given at least 60 days in advance. #views-exposed-form-manual-cloud-search-manual-cloud-search-results .form-actions{display:block;flex:1;} #tfa-entry-form .form-actions {justify-content:flex-start;} #node-agency-pages-layout-builder-form .form-actions {display:block;} #tfa-entry-form input {height:55px;} x��Xmo�8� �A�aQE��i���z�u��a�4���7/�����ql�^�"r,R|������+������✉��������N�L}ּL���}o�H.���o�#�լCa=�+��w֭+a�t����tr��zB���tL�0 ��&����a:��&r�?�>�����+[�1�,h�O�EXhU�AѧU�e�K#�CC2��55&5y�e��%�! The rule allows a plan or issuer to provide an Internet address (or similar contact information) for obtaining information about coverage or benefits instead of an SBC. SBCs are only required for plans categorized as “U.S. endobj The Guidance for Compliance and the SBC instructions provide for a special rule. 2 0 obj A description of the coverage, including: A statement of whether the plan or coverage provides minimum essential coverage and minimum value, as defined by the ACA, A statement that the outline is a summary and that the coverage document itself contains the controlling contract provisions, A contact number that people can use to ask questions or obtain a copy of the plan document or policy, When there’s a change during the plan year, During open enrollment, encourage your employees to review their address and make appropriate changes, Throughout the year, ensure all employee address changes are sent to Aetna via your monthly enrollment process. You have the right to an easy-to-understand summary about a health plan’s benefits and coverage.         - How to renew or continue coverage         - Exceptions, reductions and limitations on coverage .usa-footer .container {max-width:1440px!important;} Uniform definitions of standard insurance and medical terms. However, there is a special rule for coverage provided outside of the United States. These carrier documents, combined with open enrollment materials which typically include SMM content, will in many years satisfy the SPD/SMM requirements without any need to provide an updated wrap SPD. They will provide it to us. This can be a separate notice or an updated SBC. <>>> Summary of Benefits and Coverage Distribution Instructions. #block-googletagmanagerheader .field { padding-bottom:0 !important; } The print must be at least 12-point font. Federal government websites often end in .gov or .mil. works best with Internet Explorer 11 and above, and does not work in compatibility mode. Yes, under the final rule a plan or issuer would be required to make the uniform glossary available upon request. <> An SBC must be presented in a “uniform format.” It may not exceed four pages in length. This question helps us get you to the correct log-in screen. The .gov means it’s official. Learn more >, works best with Safari 8 and above. Special Summary of Benefits and Coverage (SBC) Distribution Timing Rules Expatriate plans are not specifically exempted from the SBC requirements. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Here are some general answers to commonly asked questions. The final rule requires that people be told they can get copies of the SBC in non-English languages. An official website of the United States government. ��"UE����P��tӨ�4�[�iD�vi��Gn�ki$�RG��6}��h^ +vBV2O�1��hl-�(B䕅yE�@A�A!��(1Q��\�p����F�(�J�-vGۿ�w��r�k�� G�L�6ً��-�Ke�^m��T%��;��ئ3�d��$�o���Sj�G�t���O�,�0�8h)4Gمz�DQ�]�U-z�g'�\*� �z��y��o�����a���d��1� Rv�� ����Ֆ�a*��í���V[º��)��=�6�t��;v�m�)o��H��� �k��6 (O�9L��t���&�66��]��:���&��d�]���r�[���v�$xl�l����M,��C�|�0�J)�p $�-�-���]2�U?͍��V��T\���k��0��c=�&U�����upE')���p7Z��2��&T���D���|�Dmh UwЅX6��n��BA�q�{�\�@��[�·s�u��h(�j�Xg$U��R)qʝ�S$G� y8���տ� l샩�I����h-Y��{x2u�}Z�!��Q��c�Uk�MTl�W��"���6��80�_q����2�����4Z���0ory�j�2�W�Umr�c�s ��B~�'����(�ɩ�|>K[q. However, beginning September 23, 2012, the ACA requires all employers to give employees a Summary of Benefits and Coverage (SBC) when their plan renews or changes. We want to help you understand how to meet your obligation to provide accurate SBC documents to employees. Group business – SBC distribution requirements. <> For language services, please call the number on your member ID card and request an operator. 3 0 obj Help us make sure we get health plan information to your employees timely and accurately: Help us get your health plan information to you timely by making sure we have your correct mailing address. The employer has seven (7) business days from the date the benefit selection is … .agency-blurb-container .agency_blurb.background--light { padding: 0; } .manual-search ul.usa-list li {max-width:100%;} The site is secure. .manual-search ul.usa-list li {max-width:100%;} These are the rules surrounding distribution of the SBC. However, there is a special rule for coverage provided outside of the United States. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Summary of Benefits & Coverage FAQs for Employers. This is called a Notice of Material Modification. Summary of Benefits and Coverage (SBC) Template | MS Word Format; Sample Completed SBC | MS Word Format; Instructions for Completing the SBC - Group Health Plan Coverage and Consumer Assistance Programs You can find the complete rules in the Federal Register. Summary of Benefits and Coverage (SBC) Templates, Instructions, and Related Materials – for plan years beginning on or after 4/1/17. .manual-search-block #edit-actions--2 {order:2;} Renewals for Group business – basics of SBC distribution requirements: The employer has seven (7) business days, starting the day they receive the benefit confirmation to issue an SBC. Method 3: Electronic Distribution of New 4-Page Summaries of Benefits and Coverage The Patient Protection and Affordable Care Act of 2010, the federal health reform law, requires many health plans to supply enrollees and individuals who are merely eligible for coverage with four-page summaries of the various coverage options available to them. Then it’s your role to provide the SBC to employees.