Departments Finally Publish Updated SBC Template and Instructions

Matthew P. Chiarello • August 11, 2016

On April 6, 2016, the Departments of Health and Human Services, Labor and Treasury (the “Departments”) issued an updated Summary of Benefits and Coverage (“SBC”) template.  The latest template represents an effort by the Departments to enhance consumer access to information regarding their health care options.

Although the new template is shorter than the prior version, it includes more detailed information about cost-sharing, deductibles and out-of-pocket limits.  Moreover, the template adds a new example describing coverage for an in-network emergency room visit.  The Departments intend that these additions will provide consumers with more meaningful information as they select their medical coverage.          

The revised SBC template must be used beginning with the first open enrollment period on or after April 1, 2017.  The updated template and the related instructions   are available on the Department of Labor website .

Under the Affordable Care Act, health plans and issuers are required to provide an SBC to all employees and beneficiaries.  An SBC must be provided during open enrollment, at initial or special enrollment and upon request.  The penalties for failure to issue SBCs can be significant, as described in our July 19, 2012 newsletter .  Specifically, the Department of Labor may assess a penalty of $1,000 per failure per participant and the Internal Revenue Service may levy an excise tax of $100 per day per affected participant.

For more information about the SBC requirement, please see our Year-End Health & Welfare Checklist and our February 23, 2015 blog .

 

Employee burnout: what it is and how to prevent it

By Mardy Gould • May 24, 2024
Employee burnout has become an epidemic in today’s modern workplace. So much so that the World Health Organization (WHO) officially recognizes it as an “occupational phenomenon.”1 While many used to consider mounting workplace stress an individual employee problem, these days, it’s become an employer’s responsibility to prevent burnout before it hurts productivity and business performance—not to mention your employees’ physical and mental health. Luckily, you can prevent burnout from affecting your workforce in several ways. This article will explore the causes and signs of employee burnout and the steps you can take to create a positive work environment where employees feel safe from toxic stress levels.

Form 720 and PCORI fee FAQs

By Mardy Gould • May 23, 2024
If you're a small business owner, you may have heard of the acronym PCORI and the fees that come with it. But what is PCORI, and how does it apply to your organization? Under the Affordable Care Act (ACA), sponsors of self-insured health plans must pay a fee to fund the federal Patient-Centered Outcomes Research Institute (PCORI). PCORI is an independent organization the ACA created to conduct research to help healthcare consumers make better decisions for their specific needs and outcomes. It also performs research related to clinical effectiveness. Employers offering a self-insured medical reimbursement health plan, such as a health reimbursement arrangement (HRA), must pay this fee by July 31 each year via Form 7201. This fee was initially set to expire in 2019, but Congress extended it through September 30, 20292, due to the Further Consolidated Appropriations Act of 20203.
More Posts