Laura DillonSenior Manager, Insurance Marketing

Today’s AgendaToday’s Agenda

• What are Summaries of Benefits and Coverage (SBCs)?

• Why am I receiving SBCs?• What is my responsibility as an employer?• When do the rules go into effect?• What does an SBC look like?• Where can I access SBCs?• Who can I talk to if I need help?• Questions and answers

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What Are What Are Summaries of Benefits Summaries of Benefits and Coverage and Coverage (SBCs)?(SBCs)?

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Overview of SBCsOverview of SBCs

• A provision of the healthcare reform law requires group health plans to provide SBCs for the plan year beginning on or after September 23, 2012.

• The SBCs are designed to be summaries describing a health plan’s benefits and coverage.

• Purpose of the SBC is to allow consumers to use SBCs as they compare insurance benefits and options apples-to-apples.

• All insurance companies and self-funded plans must follow the federal government SBC template with no deviation.

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Important ElementsImportant Elements

SBCs include important information: • The benefits covered and what a participant pays, including

deductibles and co-pays• Answers to important questions a consumer would ask

about a plan• Common medical events and services a consumer may

need• Other covered services and excluded services• A consumer’s rights to continue coverage• Claims appeals information• Coverage examples:

◦ Having a baby◦ Managing type 2 diabetes

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Why Am I Receiving SBCs?Why Am I Receiving SBCs?

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You Need to Take ActionYou Need to Take Action

• If you have medical coverage with GuideStone:◦ GuideStone will provide employers with SBCs for

the health plans they offer.• If you have a Health Reimbursement Arrangement

(HRA) with The Employee Benefits Corporation (EBC):◦ EBC or your HRA administrator will provide SBCs

for your HRA.• Employers must provide SBCs to employees and

their dependents.

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You Need to Take ActionYou Need to Take Action

• Make sure you comply!◦ Failure to provide SBCs can result in a fine

up to $1,000 per enrollee.◦ The government has extended leniency toward

penalty enforcement in 2013, but compliance is still the best course of action.

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We Will ProvideWe Will ProvideSBCs for YouSBCs for You

• GuideStone has created SBCs according to healthcare reform regulations.

• We have provided SBCs for you:1. In your annual renewal binder.2. On Employer Access.3. Online at www.GuideStone.org/Summaries.4. Through your GuideStone representative.

• As updates or changes are made to SBCs, we will provide SBCs to you ahead of any deadlines.

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What Is my ResponsibilityWhat Is my Responsibilityas an Employer?as an Employer?

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Distribute SBCsDistribute SBCsto All Employeesto All EmployeesAn employer must distribute SBCs to all eligible employees, including:

• Employees who have waived out of medical coverage.• Enrolled employees.• Newly hired employees.• Employees with qualifying events:

◦ E.g., a newborn or marriage requires you distribute an SBC.

You are not required to provide multiple copies to one family at the same address.

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When to Distribute SBCsWhen to Distribute SBCs

How to Distribute SBCsHow to Distribute SBCs

• Print in grayscale or Department of Labor (DOL) blue, if you've downloaded online versions.

• Copy double-sided (front and back).• Provide printed copies directly to employees. Placing

SBCs in a common area is not permissible. • If an employee requests an SBC electronically, you

may provide it electronically with the language you will find on slide 15. Otherwise, you must follow DOL rules for electronic delivery.

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DOL Criteria for Electronic DOL Criteria for Electronic CopiesCopiesYou must meet the criteria below to distribute SBCs electronically to an employee. If any of the criteria below is not met for an employee, you must provide that employee with printed copies of SBCs.

• Your employee must use your email system as an integral part of his or her job to be eligible to receive electronic copies.

◦ If an employee does not use your email system as an integral part of his or her job, he or she is not eligible to receive electronic copies and you must provide printed copies.

• Your email system must confirm emails withdelivery receipts.

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DOL Criteria for Electronic DOL Criteria for Electronic CopiesCopies, Continued, Continued

• You must protect employees’ confidentiality by restricting access to emails.

• You are not allowed to change the DOL-mandated format of the SBC.

• You must forward the SBC with a statement that explains the SBC’s significance and the employee’s right to a paper copy. You may use the statement below.“The Summary of Benefits and Coverage was created to help consumers more easily compare plans and understand their insurance benefits. You may also request a printed copy at any time.”

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For specific DOL criteria and rules, please read the Department of Labor’s publication29 CFR 2520.104b-1 or visit www.dol.gov/ebsa/regs/fedreg/final/2002008499.pdf.

Timeline for Distributing Timeline for Distributing SBCsSBCs

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When Do the RulesWhen Do the RulesGo into Effect?Go into Effect?

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SBC Effective DatesSBC Effective Dates

• For employees currently enrolled in a medical plan:◦ First day of re-enrollment that begins on or after

September 23, 2012.• For employees not currently enrolled in a medical

plan (newly hired, newly eligible for coverage or special enrollees):

◦ First day of the new plan year that begins on or after September 23, 2012.

• GuideStone’s new plan year begins on January 1 for most employers.

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What Does an SBC Look Like?What Does an SBC Look Like?

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Preview of an SBCPreview of an SBC

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Plan namePlan name

Answers to important questions a consumer would ask about a plan

Answers to important questions a consumer would ask about a plan

Preview of an SBCPreview of an SBC

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Helpful descriptions

Helpful descriptions

Common medical events and services a consumer may need

Common medical events and services a consumer may need

Preview of an SBCPreview of an SBC

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Excluded services

Excluded services

Claims appeals information

Claims appeals information

More covered services

More covered services

Rights to continue coverage

Rights to continue coverage

Preview of an SBCPreview of an SBC

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Coverage examples:•Having a baby•Managing type 2 diabetes

Coverage examples:•Having a baby•Managing type 2 diabetes

Where Can I Access SBCs?Where Can I Access SBCs?

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Access SBCsAccess SBCs

• Printed copies: ◦ Examples of the SBCs for the plans you currently

offer are in your renewal binder.◦ Request printed SBCs through your GuideStone

representative.• Electronic copies:*

◦ SBCs for your current plans are onEmployer Access.

◦ All SBCs are online at www.GuideStone.org/Summaries.

*DOL rules apply to distributing electronic copies to employees.

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Who Can I Talk to if I Need Help?Who Can I Talk to if I Need Help?

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Contact InformationContact Information

GuideStone• Call your GuideStone group representative• Email us: Insurance@GuideStone.org• Visit our website: www.GuideStoneInsurance.org

Department of LaborTo read the Summary of Benefits and Coverage regulations, visit www.dol.gov/ebsa/healthreform

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For up-to-date information on healthcare reform, visit For up-to-date information on healthcare reform, visit www.GuideStone.org/HealthReformwww.GuideStone.org/HealthReform

For up-to-date information on healthcare reform, visit For up-to-date information on healthcare reform, visit www.GuideStone.org/HealthReformwww.GuideStone.org/HealthReform

Questions and AnswersQuestions and Answers

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