On March 19, 2012 the IRS, DOL and HHS jointly issued Frequently Asked Questions (FAQs) Affordable Care Act Implementation (Part VIII) regarding the implementation of the Summary of Benefits and Coverage (SBC) requirements under the Affordable Care Act Implementation (Part VIII of the Act).
We provided an extensive description of the proposed SBC regulation in ErisaALERT 2011-11 and ErisaALERT 2011-12 and an overview of the final regulation in ErisaALERT 2012-05.
The FAQs are intended to answer some of the questions raised to date. The Departments intend to release additional FAQs. There are 24 Q’s and A’s in Part VIII. We will highlight some of the new guidance:
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The Departments will not impose penalties during the first year of applicability on plans and issuers working in good faith to provide the SBC in accordance with the regulations.
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A separate SBC is not required for each tier (self only, self plus one etc.) as long as the SBC is understandable.
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Model language (Q&A 12) was provided to meet the requirement to provide an e-card or postcard in connection with evergreen website postings.
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Q&A 13 addresses the culturally and linguistically appropriate language requirement. Links are provided to county information which indicates counties meeting the 10% threshold. The English version of the SBC sent to an address in which 10% or more of the population is literate in a non-English language must include a statement prominently displayed in the applicable non-English language indicating how to access the language service. A link is provided for the non-English language.
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An SBC is not permitted to substitute a reference to the SPD or other document for a required SBC content element.
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No significant changes anticipated for the 2014 SBC, however, there might be discrete changes e.g., the addition of a minimum value statement and a minimum essential coverage statement
Keep the FAQs handy as you review the SBC regulations for its application to your plan.
You may want to check our new blog periodically for quick updates on compliance issues.
Note: all links are active as of the date of issuance of this ErisaALERT.
Disclaimer: This material is for the sole purpose of providing general information and does not under any circumstances constitute legal advice and should not be used as a substitute for legal advice. You should seek the advice of counsel when applying the requirements to your plan. For more information on this ErisaALERT contact us by phone at 610-524-5351 and ask for Mary Andersen or 973-994-7539 and ask for Theresa Borzelli.
