The Department of Labor, Health and Human Services and the Treasury collectively published new FAQs regarding the requirement to provide a summary of benefits and coverage (SBC) under the Affordable Care Act (ACA) (http://www.dol.gov/ebsa/faqs/faq-aca14.html#footnotes).

The FAQs include an updated SBC template and an updated sample completed SBC (available at cciio.cms.gov and www.dol.gov/ebsa/healthreform).  It is noteworthy that the only change to the sample SBC is the addition of statements regarding whether the plan provides minimum essential coverage (MEC) (as defined in Section 5000A(f) of the Internal Revenue Code) and whether the plan meets the applicable minimum value (MV) requirements (i.e., the plan’s share of total allowed costs of benefits provided under the plan is not less than 60% of such costs).

The FAQs provide that no changes are being made to the uniform glossary or instructions to completing the SBC.

Takeaway: Plan sponsors should not need to spend time “reworking” their SBCs in connection with this new guidance if they were diligent in preparing their SBCs in the first year of applicability.

The FAQs also indicate that if a plan sponsor is already in the process of preparing its SBC for next year and it does not include the MEC and MV information in the SBC, it may provide information regarding whether the plan provides MEC and meets the applicable MV requirements in a cover letter.

Finally, the FAQs confirm that the agencies’ approach to compliance with ACA implementation is to work with employers to encourage compliance rather than to penalize employers who are working in good faith to comply with the ACA.  In connection with that approach, some of the enforcement relief published in earlier FAQs is being extended for an additional year.  This includes enforcement relief in connection with the electronic distribution of SBCs, the imposition of penalties for failing to provide SBCs, the provision of coverage examples, an issuer’s obligation to provide an SBC with respect to benefits it does not insure and enforcement regarding expatriate plans.

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Photo of Monique Warren Monique Warren

Monique Warren is a principal in the White Plains, New York, office of Jackson Lewis P.C. She counsels employers on employee benefits compliance and administrative matters, represents employers to government agencies, and prepares plan documents and related employee communications.

Monique’s expertise includes health…

Monique Warren is a principal in the White Plains, New York, office of Jackson Lewis P.C. She counsels employers on employee benefits compliance and administrative matters, represents employers to government agencies, and prepares plan documents and related employee communications.

Monique’s expertise includes health and welfare plans as well as retirement plans. She has extensive experience helping plan sponsors navigate COBRA, HIPAA, and other ERISA and Internal Revenue Code provisions and correct compliance issues. A significant part of her practice currently focuses on defending employers in federal investigations of their group health plans as well as assisting government contractors with fulfilling fringe benefit obligations. She also has extensive experience helping retirement plan sponsors comply with ERISA fiduciary requirements and the Code’s qualification requirements and correcting plan errors under the Department of Labor’s and Internal Revenue Service’s voluntary correction programs.

Photo of Melissa Ostrower Melissa Ostrower

Melissa Ostrower is Principal in the New York City office of Jackson Lewis P.C.

Ms. Ostrower advises companies on all aspects of employee benefits law, including compliance with ERISA and the Code as well as administrative matters and fiduciary issues relating to benefit…

Melissa Ostrower is Principal in the New York City office of Jackson Lewis P.C.

Ms. Ostrower advises companies on all aspects of employee benefits law, including compliance with ERISA and the Code as well as administrative matters and fiduciary issues relating to benefit plans.  Ms. Ostrower has extensive experience in executive compensation matters and counsels both public and private companies on executive compensation issues, including Section 409A and 162(m) of the Code.

Ms. Ostrower is also a member of the Jackson Lewis healthcare reform task force and is intimately involved in helping Jackson Lewis clients ensure compliance with recently enacted healthcare reform legislation.

Ms. Ostrower is a graduate of Brandeis University (B.A., M.A.), George Washington University Law School (J.D.) where she was a member of The Law Review, and New York University (LL.M.).