Next ACA Deadline Is Just Two Months Away: Employers Must Comply with Summary of Benefits Coverage (SBC) Regulations

Now that SCOTUS has upheld the ACA, it’s time to focus on new employee communications requirements in the health care reform act

Petra Marino, 781-503-4031orErin Jones, 704-664-2170

After the Supreme Court’s historic upholding of the Affordable Care Act (ACA), U.S. employers are looking at the next set of milestone regulations and seeking the most efficient way to comply. A major requirement – just several months away – is the Summary of Benefits Coverage (SBC), required to be in effect for open enrollment periods beginning on or after September 23, 2012. , the industry leader in employer health care compliance and benefits management, notes that employers must have SBCs in place not only for the plan an employee is enrolled in, but for all plans for which that employee is eligible.

SBCs are meant to benefit employees by creating “clear, understandable and straightforward information on what health plans will cover, what limitations or conditions will apply, and what they will pay for,” according to the U.S. Department of Health and Human Services.

“Under the SBC regulations, as an employee, I am entitled to an SBC for my enrolled plan but I must also be able to view the SBC for any plan I am eligible for. In corporations with multiple plans and many employees, it is an enormous logistical and communications challenge,” said Kim Buckey, principal, Compliance Communications Practice, HighRoads.

“The Supreme Court decision has given a measure of certainty to employers in planning for the future, and employers welcome this certainty,” said . “That being said, employers have a tough road ahead, as public opinion polls continue to show a widespread lack of understanding over what the law means for most people. This means that employers will need to continue to communicate aggressively and clearly with employees over their options in the coming months.”

HighRoads has been an active participant in providing to U.S. Department of Health and Human Services officials data and industry insight on communications practices and technology used to implement SBCs. on employers’ willingness to continue health benefits in light of reform was cited in the official Federal Register on SBC rules and regulations, February 14, 2012.

HighRoads is committed to delivering innovative and cost effective technology-enabled consulting for addressing the ACA and ERISA regulations. For over a decade, HighRoads has automated the benefits management and compliance process for hundreds of leading employers. In the next few weeks HighRoads recommends employers focus on these four key tasks when it comes to SBCs:

1.  – evaluate what plans you currently have and where you can consolidate SBCs.

2.  – time is of the essence. Figure out who will handle your SBCs and who will provide the data needed to complete them.

3.  – The SCOTUS decision was a landmark case. Employees will have many questions, and clear, informed communication to employees is essential. Be sure to provide some context—explain what the employee should do with the SBC and why it’s important now (and why it will be in the future).

4.  – SBCs follow ERISA electronic distribution regulations – you will need to distribute and track these documents. And, if employees do not regularly have access to a computer as part of their jobs, you must obtain their consent to receive the materials electronically. Using an automated delivery and tracking method is the optimal way to meet compliance regulations and most importantly, ensure your employees are receiving the needed information.

“Now is the time to begin work in earnest on SBCs, to finalize 2013 plan designs, and to prepare a communication strategy that encompasses not only this fall's open enrollment but the impact of exchanges in 2014,” added Buckey.

For a copy of the HighRoads webinar with Foley Hoag on the SCOTUS ruling please visit . To see how well your company is prepared, visit the HighRoads Compliance Assessment tool at .

The world’s leading employers choose HighRoads to gain complete control over their health care costs and compliance. HighRoads’ SaaS-based solutions provide employers with complete benefits management capability, including benefits plan information and pricing, competitive benefits benchmarks, and complete benefits management. The privately-held company is headquartered in Woburn, MA. For more information, visit .

Suggested Articles

The profit margins and management of Community Health Group raise questions about oversight of managed care insurers.

Financial experts are warning practices about the pitfalls of promoting medical credit cards to their patients.

A proposed rule issued by HHS on Tuesday would expand short-term coverage, a move Seema Verma said will have "virtually no impact" on ACA premiums.