Summary of Benefits and Coverage Highlights and Frequently Asked Questions - Bim Group

Summary of Benefits and Coverage Highlights and Frequently Asked Questions

A Summary of Benefits and Coverage (SBC) is a four-page (double-sided) communication required by the federal government. It must contain specific information, in a specific order and with a minimum size type, about a group health benefit’s coverage and limitations.

For fully insured plans, the insurer is responsible for providing the SBC to the plan administrator (usually this is the employer). The plan administrator and the insurer are both responsible for providing the SBC to participants, although only one of them actually has to do this.

For self-funded plans, the plan administrator is responsible for providing the SBC to participants. Assistance may be available from the plan administrator’s TPA, advisor, etc., but the plan administrator is ultimately responsible. (The plan administrator is generally the employer, not the claims administrator.)

Download our Highlights of the SBC Advisor for a quick overview of the SBC requirements.

Download the SBC FAQ Advisor to get answers to these questions and more:

  • When is an SBC required?
  • What information must be included in an SBC?
  • What changes have been made to the SBC for 2017 through 2021?
  • How do I handle stand-alone benefits like dental and vision?
  • How often do I need to update the SBC?
  • How do I prepare the coverage examples?
  • Who is responsible for providing an SBC?
  • Who must receive an SBC, and when?
  • Can I provide the SBC electronically?
  • What happens if I don’t provide an SBC?

 

This information is general and is provided for educational purposes only. It reflects UBA’s understanding of the available guidance as of the date shown and is subject to change. It is not intended to provide legal advice. You should not act on this information without consulting legal counsel or other knowledgeable advisors.

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