Summaries of Benefits and Coverage SBCs Laura Dillon

Summaries of Benefits and Coverage (SBCs) Laura Dillon Senior Manager, Insurance Marketing

Today’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 2

What Are Summaries of Benefits and Coverage (SBCs)? 3

Overview 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. 4

Important 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 5

Why Am I Receiving SBCs? 6

You Need to Take Action • If you have medical coverage with Guide. Stone: ◦ Guide. Stone 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. 7

You 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. 8

We Will Provide SBCs for You • Guide. Stone 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. Guide. Stone. org/Summaries. 4. Through your Guide. Stone representative. • As updates or changes are made to SBCs, we will provide SBCs to you ahead of any deadlines. 9

What Is my Responsibility as an Employer? 10

Distribute SBCs to All Employees An 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. 11

When to Distribute SBCs At every triggering event Requirement When you hire a new employee Include SBCs in the enrollment packet When an employee becomes eligible for medical coverage Include SBCs in the enrollment packet When an employee asks you for summary information Provide SBCs within seven business days When an employee asks you for the glossary Provide the glossary within seven business days When qualifying events happen Provide SBCs within 90 days of the enrollment When you renew annually Provide SBCs no later than 30 days prior to the new plan year When a health plan changes (Guide. Stone will notify you) Provide SBCs within 60 days prior to the effective date of the change

How 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. 13

DOL Criteria for Electronic Copies You 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 with delivery receipts. Continued on next slide 14

DOL Criteria for Electronic Copies, 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. ” For specific DOL criteria and rules, please read the Department of Labor’s publication 29 CFR 2520. 104 b-1 or visit www. dol. gov/ebsa/regs/fedreg/final/2002008499. pdf. 15

Timeline for Distributing SBCs 2012 September 23 October November 2013+ December 12 January 1 September 23 October 12 January 1 — ongoing SBCs go into effect. Send SBCs to all employees during re-enrollment. Send SBCs: • Guide. Stone will send you printed copies of the • An example of SBC for all of your selected plans. the SBCs are • For electronic distribution and for future SBC in your needs, download copies from Employer Access or Guide. Stone www. Guide. Stone. org/Summaries. 2013 renewal binder. • To new hires • To employees who are newly eligible for coverage • To employees experiencing qualifying events • Upon request • During annual re-enrollment 16

When Do the Rules Go into Effect? 17

SBC 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. • Guide. Stone’s new plan year begins on January 1 for most employers. 18

What Does an SBC Look Like? 19

Preview of an SBC Plan name Answers to important questions a consumer would ask about a plan 20

Preview of an SBC Helpful descriptions Common medical events and services a consumer may need 21

Preview of an SBC Excluded services More covered services Rights to continue coverage Claims appeals information 22

Preview of an SBC Coverage examples: • Having a baby • Managing type 2 diabetes 23

Where Can I Access SBCs? 24

Access SBCs • Printed copies: ◦ Examples of the SBCs for the plans you currently offer are in your renewal binder. ◦ Request printed SBCs through your Guide. Stone representative. • Electronic copies: * ◦ SBCs for your current plans are on Employer Access. ◦ All SBCs are online at www. Guide. Stone. org/Summaries. *DOL rules apply to distributing electronic copies to employees. 25

Who Can I Talk to if I Need Help? 26

Contact Information Guide. Stone • Call your Guide. Stone group representative • Email us: Insurance@Guide. Stone. org • Visit our website: www. Guide. Stone. Insurance. org For up-to-date information on healthcare reform, visit www. Guide. Stone. org/Health. Reform Department of Labor To read the Summary of Benefits and Coverage regulations, visit www. dol. gov/ebsa/healthreform 27

Questions and Answers 28