Analysis of Summary of Benefits and Coverage Requirement

Source: United Benefit Advisors

Employers have a number of obligations under the Patient Protection and Affordable Care Act (PPACA), including how they inform employees about their health plans. Most importantly, employers must provide a Summary of Benefits and Coverage (SBC) for group health plans, with several underlying requirements that the SBC must meet.

All employers, regardless of size or type (private, government, not-for-profit), including grandfathered plans, must meet the SBC requirements. Health Care Reform Central has multiple downloads breaking the SBC requirements down into easy-to-understand language employers can utilize at no cost.

In addition to knowing how to treat different employees throughout the year (new hires, open enrollment employees, retirees, special enrollees), the SBC requirement contains very detailed information about:

  • How an SBC can be distributed (electronic vs. paper).
  • Penalties if an employer fails to provide an SBC.
  • Alternate language requirements.
  • Content that the SBC must contain, including coverage examples.
  • Which types of plans are required to provide an SBC, and which benefits must be covered.
  • When an SBC is NOT needed.

Health Care Reform Central includes up-to-date information on a number of elements, including Counting Employees, Exchange Eligibility/IRS Non-calendar-year plans, Wellness Proposed Rules, FSA and SBC Highlights, W-2 Reporting Requirements, Medicare Withholding Summary, Essential Benefits/Actuarial Value, and more.

Health Care Reform Central can be found here.

In addition to Health Care Reform Central, Megro provides customized benchmarking data to help businesses compare their employee health benefits to competitors, and find savings through plan design. UBA’s 2012 Health Plan Survey, the largest in the nation with nearly 12,000 employers participating, along with the collective wisdom of its 140 industry leading Partner Firms, helps business owners and human resource executives make informed decisions that directly impact the bottom line by controlling the upward spiral of health care costs.



Fairmount Benefits Company

Two Radnor Corporate Center
Suite 110
Radnor, PA 19087

    Email Us