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New SBC Guidance and Templates
04/24/2013

The latest set of Affordable Care Act FAQs (Part XIV) announces the release of updated templates for the SBC and uniform glossary. The updated templates are designed to provide employers and insurers with tools to comply with the SBC requirement for the second year of applicability.

Note that many fiscal-year plans may not yet have begun their first year of applicability for the SBC requirement, which essentially begins with the first open-enrollment period beginning on or after September 23, 2012.

Limited Template Changes. The updated templates reflect only two significant changes. They add language for describing whether the coverage does (or does not) provide minimum essential coverage (MEC), and they add language for describing whether the coverage does (or does not) provide minimum value (MV). There is no change in the language describing whether benefits are (or are not) subject to annual limits, and the template keeps the same two coverage examples (childbirth and diabetes).

Extended Enforcement Relief. Perhaps the most significant guidance in the FAQs is an extension of much of the helpful enforcement relief that was provided through previous FAQs. For example:

  • Compliance emphasis. IRS, DOL, and HHS will continue to emphasize "assisting (rather than imposing penalties on) plans, issuers and others that are working diligently and in good faith to understand and come into compliance with the new law" (Part VIII, Q2) and "will not impose penalties on plans and issuers that are working diligently and in good faith to comply" (Part IX, Q8).
  • Electronic distribution. The additional safe harbor for electronic distribution in connection with online enrollment or renewal (Part IX, Q1) will continue to be available.
  • Multiple SBCs for one plan. Where benefits under a single plan are insured by two different carriers, or are partly insured and partly self-insured, each carrier is only responsible for providing an SBC for the benefits it insures, and multiple partial SBCs may continue to be used for that one plan. (Part IX, Q10)

Effective Date and Reliance. The new templates and guidance apply to plan years beginning on or after January 1, 2014 and before January 1, 2015 and may be relied on for preparation and distribution of SBCs during that period.
 

 


Editors
Don Berner Image
Don Berner, the Labor Law, OSHA, & Immigration Law Guy
Boyd Byers Image
Boyd Byers, the General Employment Law Guy
Jason Lacey Image
Jason Lacey, the Employee Benefits Guy
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