If a group health plan or health insurance issuer have made any material modification (during the plan year) in terms of the plan or coverage involved that’s not reflected in the most recent Summary of Benefits and Coverage (SBC), the plan or issuer must provide notice of the modification to enrollees within 60 days of the effective date of the modification.
The Summary of Benefits and Coverage and the uniform glossary must be provided to consumers the 1st day of the 1st plan year after September 23, 2012, or the 1st day of the 1st open enrollment period after this date. They may be provided either:
- electronically in connection with online enrollment or renewal, but must provide the option to receive a paper copy, or
- on a single webpage
In an individual market or for group health plan/sponsors, it must be provided no later than 7 business days after receiving a “substantially complete” application.
The penalty for willfully failing to provide the required information is up to $1,000 per instance. However, during this first year of applicability, there are no penalties on plans and issuers that are working diligently and in good faith to comply with the final regulations.
If you would like a White Paper on the Summary of Benefits and Coverage requirement, please click here.
