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Summary of Benefits and Coverage

December 13, 2012

According to new regulations of the PPACA, a Summary of Benefits & Coverage must be provided to employers and individuals “when shopping for coverage, enrolling in coverage, at each new plan year, and within seven business days of requesting a copy from their health insurance issuer or group health plan.”

Our interpretation is that the carrier must provide the SBC to participants and others who qualify for coverage.  This has to be done effective for plan/policy years and open enrollments beginning on or after September 23, 2012, health insurers and self-insured group health plans will be required to provide a standard summary of benefits and coverage.

Blue Cross Blue Shield of Michigan and Blue Care Network provides the SBC and is planning on being ready to provide the SBC to all of their customer groups.  The SBC must be distributed with other open enrollment materials for open enrollments that begin on or after September 23, 2012, and by the first day of coverage if the content has changed. The information must be provided to all employees during open enrollments starting with the first open enrollment that begins on or after September 23, 2012.

If you would like clarification or more information about an SBC, please contact us today at (800) 362-5461.

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