Blue Cross and Blue Shield of Illinois

 

September 27, 2013

Legislative Update
Affordable Care Act Question of the Week: Summary of Benefits and Coverage

The “Question of the Week” answers frequently asked questions regarding the Affordable Care Act (ACA). This week’s question addresses the Summary of Benefits and Coverage (SBC).

Q. What is the process for creating an SBC for fully insured or ASO groups for a Jan. 1, 2014, effective date and beyond?

A. By law, the insurer and the employer each have the independent responsibility of creating and distributing the SBC for fully insured health plans. The law makes it the employer’s responsibility to create and distribute the SBC for self-insured plans. The health insurer has no legal obligation to do so.

Here is the process for each type of group:

Fully Insured Groups
Our approach to fully insured groups:

  • We will create the SBC for all fully insured plans and ensure that information is accurate.
  • We will only create the SBC for medical benefits that we administer. The employer is responsible for gathering information for benefits that we do not administer.

    • For standard fully insured plans, the group administrator will access the SBC using our SBC Tool and will distribute it to members. A link with access instructions to our SBC site has been distributed to all group administrators. Group administrators will have the ability to log on to the site to access their plan’s SBC.
       
    • For custom fully insured plans, the account executive (AE) will request Blue Cross and Blue Shield of Illinois’ (BCBSIL) services to create the SBC per the Benefit Program Application (BPA). The AE and/or the plan administrator will validate and approve the information in the SBC. The AE will provide the completed SBC electronically to the group administrator, who will distribute it to members per the BPA.
       
  • We will provide translation services and provide the SBC in foreign languages in accordance with the regulation. The employer must request the SBC in a foreign language. We will not automatically provide SBCs in foreign languages.

Self-Insured Groups
The law makes it the employer’s responsibility to create and distribute the SBC for self-insured plans. BCBSIL has no legal obligation to do so.

Our approach to self-insured groups:

  • We will create the SBC for self-insured groups that request our services per the Benefit Program Application (BPA).
  • The account executive (AE) and/or the plan administrator will validate and approve the information in the SBC.
  • The AE will provide the completed SBC electronically to the group administrator, who will distribute it to members per the BPA. If an ASO client requests BCBSIL to print and mail the SBC to subscribers, a fee will be assessed as noted on the BPA.
  • We will provide translation services and provide the SBC in foreign languages in accordance with the regulation. The employer must request the SBC in a foreign language. A fee will be assessed. We will not automatically provide SBCs in foreign languages.
 
.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.