The 24 FAQs address various issues related to the requirement that group health plans provide participants and beneficiaries with an SBC containing specific information about the plan and coverage, at certain times during the enrollment process and upon request, including clarification relating to:
- Combining certain information with respect to different coverage tiers, different cost-sharing selections (such as levels of deductibles, copayments, and co-insurance), and different add-ons to major medical coverage that could affect cost-sharing and other information in the SBC (such as FSAs, HRAs, HSAs, or wellness programs) into one SBC;
- The requirement to provide SBCs to individuals who are COBRA qualified beneficiaries;
- Circumstances under which an SBC may be provided electronically;
- Model language for meeting the requirement to provide an e-card or postcard in connection with evergreen website postings;
- The requirement to provide the SBC in a culturally and linguistically appropriate manner;
- The impermissibility of substituting a cross-reference to a plan’s summary plan description (SPD) or other documents for any content element of the SBC;
- Making certain minor changes to the SBC format and language; and
- The option to include a statement in the SBC about whether a plan is a grandfathered health plan.
The FAQs also make clear that, during the first year of applicability for the new SBC rules, penalties will not be imposed on plans and issuers that are working diligently and in good faith to provide the required SBC content in an appearance that is consistent with the final regulations. This is consistent with the federal agencies’ basic approach to the implementation of Health Care Reform, which emphasizes assisting (rather than imposing penalties on) plans, issuers and others that are working diligently and in good faith to understand and come into compliance with the new law.