Health Insurance

Summary of Benefits As Required by Affordable Health Care Act

Dear Employer Group:

As part of the Affordable Care Act (ACA), the Department of Health and Human Services (HHS) has established standard templates that health insurers must use to summarize their benefits. These documents will make it easier for consumers to understand their benefits and compare coverage options.

What this means to you
The enclosed summary of benefits and coverage (SBC)* must be supplied to all of your employees who are eligible for your group insurance (not just those currently enrolled in our plan). Before distributing it, please take the opportunity to review the benefits described to be sure this is the benefit package you have agreed to offer. We recommend that you send it to employees along with any other key details necessary for finalizing their health coverage decision (e.g., employee contribution levels and information on their application process).

Why this is important
According to ACA regulations, the SBC must be issued to all eligible employees within seven business days of the employer’s written intent to purchase or renew health coverage. If the SBC is not provided by the plan or the group in a timely fashion, a fine of up to $1,000 per employee may be levied against both the employer and CDPHP. The New York State Department of Financial Services (NYSDFS) is also authorized to impose fines.