Update: Summary of Benefits and Coverage (SBC)
Beginning September 23, 2012, the Affordable Care Act (ACA) will require all health insurers to provide a Summary of Benefits and Coverage (SBC) for insured commercial products offered to direct pay individuals (including Healthy New York) and insured employer groups. The SBC will make it easier for members to understand their benefits by placing them in a template alongside a uniform glossary of commonly used health insurance terms.
The next issue of Broker News will feature updated information including how to request SBCs for your groups. In the meantime, answers to some of your most frequently asked questions can be found below. Additional information on SBCs can be found on our Health Care Reform website in the Resources tab.
Q. When will Excellus BCBS begin sending SBCs?
A. According to the regulations SBCs must be provided to employer groups and members beginning 9/23/12.
- SBCs must be provided to new employer groups and direct pay individuals looking to enroll on or after 9/23/2012.
- SBCs must be provided to existing employer groups, group members, and direct pay enrollees upon their first renewal on or after 9/23/2012.
- SBCs must be provided within 7 days upon request beginning 9/23/2012.
Q. Will Excellus BCBS create SBCs for self‐funded groups?
Q. What products are excluded from the SBC requirement?
A. Medicaid, Family Health Plus, Child Health Plus, Medicare Advantage, Medicare Supplemental, standalone dental and stand‐alone vision products are excluded from the SBC requirement.