SUMMARY OF
BENEFITS AND
COVERAGE
Toolkit for employers
June, 2013
CIGNA’S TOOLKIT WILL HELP YOU PREPARE
Although there is no requirement to notify employees they will be receiving
SBCs, Cigna has developed this toolkit to help you understand the
requirements and communicate key messages to your employees
Toolkit Contents
• Overview of the SBC requirements and timing
for Human Resources
• Additional slides at the end to incorporate into
your enrollment meeting presentations
• Information you can include in an employee
newsletter, email or enrollment materials
© 2012 Cigna
2
OVERVIEW: SUMMARY OF BENEFITS AND COVERAGE
Intent:
Provide individuals with HHS-defined standard information to compare plans and make decisions
Four-Page Benefit
Summaries
Coverage
Examples
Impact:

Required for insured and selfinsured medical plans
 Not required for retiree-only,
Medicare, stand-alone dental/vision
Customer
Service # and
Website
&
Glossary
Penalty:
$1,000 per enrollee per violation for
“willful” non-compliance
Allowance made for “good faith” efforts
Effective:
For enrollment periods beginning on or after September 23, 2012
For new hires or special enrollments beginning in the first plan year starting
on or after September 23, 2012
3
FINAL RULE ISSUED FEBRUARY 9, 2012
Feature
Versions
Final Rule
• SBC required for each plan
• One SBC can show all coverage tiers
Appearance
• 12 point – no font specified
• Must use template, but “best efforts” allowed for
plan terms that can’t easily be described
consistent with the instructions (e.g., wellness)
Content
• Premium not required
• 2 standard coverage examples (birth of a baby
and type 2 diabetes management)
• Must include carved out benefits such as
prescription drugs or mental health
Delivery
• Electronic delivery permitted in accordance with
ERISA electronic document rules
• Acknowledgement not required
Combining with other Materials
© 2012 Cigna
• May be combined with other materials, but must
be prominent
4
WHEN SBCs MUST BE PROVIDED TO EMPLOYEES
Situation
Trigger
Timing Requirements
• Active enrollment/Manual renewal:
With open enrollment materials
Annual
enrollment
• Enrollment periods beginning on or
after September 23, 2012
Mid-year benefit
changes
• Benefit changes made during the
year
• 60 days before the change is
effective if the change impacts the
SBC information
New employee
• Mid-year enrollment
• With enrollment materials
Special
enrollment
• HIPAA special enrollment event
• Within 90 days after enrollment
Employee
request
• Any time an employee requests an
SBC
• Within 7 business days
© 2012 Cigna
• Passive enrollment/Automatic
renewal:
30 days prior to first day of plan year
5
IF YOU MAKE A BENEFIT CHANGE AFTER YOU HAVE ALREADY
PROVIDED THE SBC …
Modified
before
first day
of plan
year
© 2012 Cigna
SBC had
been
provided
with OE
Reissue
SBC by
the date
coverage is
effective
6
ROLES AND RESPONSIBILITIES
Fully insured employers
Self-insured employers
Cigna will produce and provide SBCs to you
for delivery to your employees as required
You are responsible for producing and
distributing SBCs
Cigna can help you develop your SBCs
© 2012 Cigna
7
http://www.cms.gov/cciio/Resources/Forms-Reports-and-Other-Resources/index.html#
SUMMARY OF BENEFITS AND COVERAGE – SAMPLE
COMPLETED PAGE 1
© 2012 Cigna
8
OVERVIEW: MANDATORY SBC TEMPLATE, PAGE 7
http://www.cms.gov/cciio/Resources/Forms-Reports-and-Other-Resources/index.html
© 2012 Cigna
9
Slides for
Enrollment Meeting
Presentations
The following slides are designed to
introduce SBCs to employees during
your enrollment meetings
SUMMARY OF BENEFITS AND COVERAGE (SBC)
• Required by Health Care Reform
• Standard information about medical plans that all employers must
provide to employees during benefits enrollment
• Designed to help employees understand benefits and compare
plans
• Delivered with open enrollment materials
• Reissued any time mid-year benefit changes impact the SBC
content
11
FOUR REQUIRED COMPONENTS OF THE SBC REGULATIONS
1. Summary of Benefits and Coverage
– Chart that shows how the plan covers various services such as office visits,
hospitalization and prescription drugs
2. Coverage Examples
– Illustration of how the plan might pay under these medical scenarios: having a baby
and treating type 2 diabetes
3. Customer Service
– Phone number and website
4. Glossary of Health Coverage and Medical Terms
– Definitions for common health insurance terms such as deductible and coinsurance
– Available on your own intranet and/or on
http://www.cms.gov/cciio/Resources/Forms-Reports-and-Other-Resources/index.html
12
© 2012 Cigna
13
© 2012 Cigna
14
15
© 2012 Cigna
16
EMPLOYEE ANNOUNCEMENT – BOILERPLATE COPY
• Although we are entering the second year of the SBC requirement, if you have
not yet introduced the SBC to your employees, the attached Word document
contains sample language that you can use in an employee email, benefit
newsletter article or enrollment materials.
Employee
Messaging English
Employee
Messaging Spanish
Visit InformedOnReform.com
You’ll find tools, facts, news and
information on our award-winning
website to help you understand and
comply with health care reform
"Cigna" is a registered service mark, and the "Tree of Life" logo and “GO YOU” are service marks, of Cigna
Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and
services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating
subsidiaries include Connecticut General Life Insurance Company (CGLIC), Cigna Health and Life Insurance
Company (CHLIC), and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental
Health, Inc. In Arizona, HMO plans are offered by Cigna HealthCare of Arizona, Inc. In California, HMO and
Network plans are offered by Cigna HealthCare of California, Inc. In Connecticut, HMO plans are offered by Cigna
HealthCare of Connecticut, Inc. In North Carolina, HMO plans are offered by Cigna HealthCare of North Carolina,
Inc. All other medical plans in these states are insured or administered by CGLIC or CHLIC.
000000 00/13 © 2013 Cigna. Some content provided under license.