The US Department of Labor (“DOL”) has released frequently asked questions (“FAQs”) regarding implementation of the federal health care reform law’s summary of benefits and coverage requirement. (This set of FAQs is Part VIII in the general series about implementation of the law.) See our earlier blog post regarding the summary of benefits and coverage regulations that were issued last month.

Among other things, the FAQs (released March 19, 2012) clarify certain points regarding the distribution of summaries of benefits and coverage (“SBC”): The SBC must be provided beginning with the first day of the first open enrollment period that starts on or after September 23, 2012. It must be given to COBRA participants as well as active employees. It must be provided to individuals eligible to enroll outside the open enrollment period beginning with the first plan year that starts on or after September 23, 2012. The SBC can be provided electronically to covered individuals as long as the existing DOL electronic disclosure rules are satisfied. For eligible individuals who are not covered, employers can provide the SBC electronically as long as the format is readily accessible and a free paper copy is provided upon request.       

The FAQs also clarify that certain changes to the SBC content and format are permissible: Information about premium costs and whether the plan is grandfathered may be added to the SBC. Plans and issuers can combine, in a single SBC, information for different coverage tiers, cost-sharing options, and add-ons (such as FSA’s, HRA’s and wellness programs). Finally, the FAQs provide that the SBC table column and row sizes may be altered to accommodate the amount of information and information in a row can roll from one page to the next.   

The DOL reiterated that the federal enforcement agencies’ collective focus is to help plans and insurers to comply with the regulations, as opposed to penalizing them for noncompliance. Other than the addition of minimum value and minimum essential coverage statements for 2014, changes reflecting the elimination of annual limits, additional coverage examples, and refinements described in the FAQs, the DOL does not anticipate more changes to the SBC template. The DOL also stated that it intends to release additional FAQs on the SBC requirement.