Summary of Benefits and Coverage (SBCs)

When Do I Need to Distribute SBCs?
The Affordable Care Act (ACA) requires insurers to offer employees and dependents an easy-to-understand summary of coverage so they can easily compare options based on price, benefits, and other features considered important.

Specifically, the ACA requires insurance companies and employer-based plans to provide:

  • A short plain-language Summary of Benefits and Coverage (SBC)
  • A Uniform Glossary of health coverage and medical terms developed by the National Association of Insurance Commissioners (NAIC) to help consumers understand commonly used terms like "deductible” and “coinsurance.”

The SBC includes details, called coverage examples, which show what a plan would cover in two common medical situations, including diabetes care and childbirth.

It’s important employers distribute the correct SBC documents in the specified timeframe, as required by the Department of Labor

  • At Initial and open enrollment:  With open enrollment materials; if no open enrollment, must be provided before the date an employee is first eligible to enroll.

  • Automatic re-enrollment:  At least 30 days before 1st day of next plan year; or within 7 days after policy is issued.

  • HIPAA Special Enrollment:  Within 90 days after enrollment (same as for SPDs), must provide SBC for benefit option in which employee enrolls. Must provide SBC earlier if individual requests it.

  • Upon request: As soon as possible but within 7 business days after request

  • Material change: A group health plan must provide an SBC automatically 60-days in advance on mid-year material modification to coverage that affects the content of an SBC