On Februray 9, 2012, final regulations were released regarding the Summary of Benefits and Coverage (SBC) and Uniform Glossary requirements for health insurance plans. The goal is to provide consumers with simple information on plan coverage and help consumers better understand the coverage they have in order to compare differences in benefits and coverages when they are shopping for a new plan.
Beginning on the first day of the first open enrollment period that begins on or after September 23, 2012, plans must provide the SBC to participants and beneficiaries who enroll or re-enroll for coverage during the open enrollment period. Additionally, an SBC must be provided to all participants and beneficiaries who do not enroll during an open enrollment period, including newly eligible individuals and special enrollees, on the first day of the first plan year that begins on or after September 23, 2012.
An SBC must be provided as either a stand alone document or in combination with other summary materials, but it must be prominently displayed at the beginning of the document. A template of the SBC is available for use here from the U.S. Department of Labor, in addition to the Uniform Glossary. Groups are also required to provide participants and beneficiaries who reside in a county where 10% or more of the population is literate in the same non-English language, a copy of the SBC and Uniform Glossary in the non-English language. The Department of Health and Human Services has agreed to provide written translations of the SBC template to comply with this requirement and post on their website.
Be sure to visit the U.S. Department of Labor Health Reform website for full details and instructions regarding the latest SBC regulations, and as always, feel free to contact us at MedCon Benefit Systems with any questions.
With the economic recovery continuing to be slow and companies under pressure to overcome a number of challenges, the employee benefits landscape is continuing to change. Rising healthcare costs, new mandates of reform and economic influences are just some of the reasons employees are looking for solutions for the highest potential return on investment. Here are some tips from our benefit professionals on how to maximize your investments.
1. Work with a benefits consultant / advisor who can help you design a “healthcare reform” strategy that includes a consumer directed approach with financial protection.
2. Get the best overall value and experience by partnering with those who can provide expertise and experience in delivering both self funded and employer funded benefits as well as voluntary benefits.
3. Engage your consultant to maximize the value of your benefits by meeting the financial protection needs of your various workforce diversities. Offer a range of benefit choices and include effective benefits education for your employees.
4. Optimize your ROI with helpful services such as employee assistance programs, helpful management of absences from FMLA and various state laws to streamlining HR time with benefits administration and technology solutions. Consider outsourcing services to our sister company, Employee Resource Administration
, to help with all of your non-revenue producing functions.
You have no doubt been inundated with HealthCare Reform news- how the healthcare insurance landscape will see changes. Most of what is being discussed, like employers paying penalties for not sponsoring a health plan is not effective until 2014.
So, what are the key changes you need to be dealing with NOW?
1. Effective with renewals on or after September 23, 2010 plans that offer dependent coverage must extend that coverage to dependents up to their 26th birthday, even if they are married and not living at home, unless they are eligible for group coverage elsewhere.
2. Insurance carriers can not deny claims on children (under the age of 19) related to pre-existing conditions, again for renewals on or after September 23, 2010.
3. Health plans can not impose lifetime limits on the dollar value of coverage for plans that renew on or after September 23, 2010.
This is just a sample of some of the changes and impact of the HealthCare Reform, for more information check back or call us at 214/739-5215.