Effective upon your group renewal after 9/23/2012 (i.e., 10/1/12 renewals and beyond), Employers are now responsible for distributing the new Summary of Benefits and Coverage (SBC) required by Obama’s Patient Protection and Affordable Care Act, to all eligible enrollees and beneficiaries within the regulatory time frames outlined below. Your health plan carrier will be sending the 8-sided summary for the employer to make available to your employees. This summary is provided in addition to the usual 2 to 4 page benefits summary typically provided by your health plan. The purpose of the new SBC is to provide basic health plan coverage information in a standardized format across all health insurance plans. Please be aware of the employer notification requirements listed below. Contact DDI with any questions about compliance with this new regulation.
During open enrollment: Along with other written application materials that are required for enrollment or renewal, no later than 30 days prior to the first day of coverage. If multiple choices are available to eligible enrollees a Summary of Benefits and Coverage for each choice must be provided at this time.
Renewal changes: If benefit changes are made during the renewal process, a new Summary of Benefits and Coverage reflecting these changes will be provided. The new document must be distributed to your employees no later than the first day of coverage.
When newly eligible: Newly hired and newly eligible enrollees must be provided a Summary of Benefits and Coverage for each plan for which they are eligible by the date they become eligible for coverage.
Upon request: The Summary of Benefits and Coverage must be provided to any eligible enrollee or beneficiary within seven business days of the request. (Employees may also request a copy directly from the health plan).
Thank you for your attention to this matter.
Health Reform Reminder – Preventive Services are now covered at 100%
Under the Patient Protection and Affordable Care Act health insurance plans are required to cover a variety of preventive care services without you having to pay a copayment or co-insurance or meeting your deductible. This applies only when these services are delivered by a network provider on your plan. For a complete list of services covered go to www.healthcare.gov or click on this link http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html
Many services previously required a copay or deductible and co-insurance. Please forward this information to your employees.
As always, contact us with any questions
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