More Employers Producing SBCs In-House

In 2013, twice as many employers produced the Patient Protection and Affordable Care Act (ACA)-required Summary of Benefits and Coverage (SBC) in-house, rather than having a third party create it for them, according to recent research from benefits plan management firm HighRoads. The survey found that 40 percent of employers created the necessary SBCs in-house in 2013 (up from 18 percent in 2012). In 2012, 53 percent had a third party administrator create the necessary SBCs; in 2013, this dropped to 36 percent.

SBCs. The ACA requires that group health plans and health insurers provide participants with a SBC. The SBC must be a concise summary of the key benefits and coverages provided through the health plan, the costs to the participants, lists of excluded services, and other significant conditions or limitations. The SBC is limited to four double-sided pages, and was designed to provide participants with an easy-to-understand way to compare different plan options.

The HighRoads survey, Fifth Annual Compliance Trends Survey Findings and Observations, noted that about two-thirds of employers expected to produce fewer than 10 SBCs for 2013. However, 30 percent produced between 10 and 100 SBCs, and 9 percent expected to produce 100 or more separate SBCs. Most employers (83 percent) indicated that the amount of SBCs produced for 2013 was not different from the amount created in 2012, although 13 percent said they had to create additional SBCs for 2013.

In 2013, employers were required to validate whether their plan met minimum value standards on the SBCs. Most (73 percent) relied on their actuaries for determining whether their plan met the minimum value standards. Twenty-three percent relied on their health insurance carrier for that information, and only 5 percent used the calculator provided on the Department of Labor website.

Notice of coverage options. For the first time in 2013, employers also were required to provide employees with a notice of coverage options available in the health insurance marketplaces. The notice is required to inform employees: (1) about the health insurance marketplaces; (2) that, depending on their income and what coverage may be offered by the employer, employees may be able to get lower cost private insurance in the marketplace; and (3) that if they buy insurance through the marketplace, they may lose the employer contribution (if any) to their health benefits.

The HighRoads survey found that given the relatively simple nature of the form, 68 percent of employers planned on producing the notice of coverage options in-house. Twenty-four percent were relying on their consultants to produce the notice, and only 12 percent were using their health insurance carriers to generate the notice.

For more information, visit http://www.highroads.com/compliance-trends2014/.

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