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Are You Prepared to Distribute Summaries of Benefits and Coverage?

August 2012

By: Peter E. Hansen, Esq.

Employers with group health plans, health reimbursement accounts, or certain flexible spending accounts must be prepared to comply with Summaries of Benefits and Coverage (SBC) regulations by September 23, 2012. The regulations concerning SBCs - which are four-page, double-sided documents that explain the benefits and coverage available under a health plan - will affect each employer differently. For example, if your health plan is fully insured, then your insurance carrier will create and provide to you an SBC covering the portion of the plan that it secures, and your responsibility will be limited to distributing the SBCs to plan participants and beneficiaries. However, if your health plan is self-insured, then you will be responsible for both creating and distributing the SBCs. Fortunately, the Department of Labor provided a template for employers (and health insurance carriers) to use when creating the SBCs, available at www.dol.gov/ebsa/SBCtemplate.doc.

Employers must distribute the SBCs to plan participants and beneficiaries with the open enrollment materials for the first plan year beginning on or after September 23, 2012 or upon employee request. As a result, if your 2012 open enrollment period already passed or will pass before September 23, you need not distribute SBCs until 2013 unless an employee requests the SBC. Of course, all employers should be prepared to distribute SBCs regardless of their open enrollment period - if an employee requests an SBC, then you must provide it to the requesting employee within seven business days, and penalties for non-compliance range from $100 per day to $1,000 per violation.

Questions? Please contact WS Attorney Peter E. Hansen at (262) 560-9696, or email pehansen@wesselsherman.com .