PPACA IMPLEMENTS SBC RULES

Health insurers and group health plans will be providing you with an updated, easy-to-understand Summary of Benefits and Coverage, or SBC document.  It will contain a uniform glossary of terms that is commonly used in health insurance coverage as well as coverage examples.  The SBC will allow you to make “apples to apples” comparisons of your insurance options.

An SBC must include the following:

  • A description of coverage;
  • Exceptions, reductions and limitations of the coverage;
  • Cost-sharing provisions;
  • Renewability and continuation of coverage provisions
  • Coverage examples (currently, two examples are required, illustrating plan coverage of a pregnancy and of a person with well-controlled type 2 diabetes);
  • A statement that the SBC is only a summary;
  • Contact information for questions and obtaining a copy of the plan document of policy;
  • An Internet address for obtaining a list of network providers and information on the prescription drug formulary; and
  • An Internet address for obtaining the glossary of health coverage and medical terms.

A Summary of Benefits and Coverage must be provided at the following times:

  • Within 7 business days after receipt of an application for health coverage;
  • By the first day of coverage, if there are any changes in the initial SBC;
  • If written application for renewal is required, no later than the date the written application materials are distributed;
  • If renewal is automatic, at least 30 days before the beginning of the new plan or policy year; and
  • Within 7 business days after receipt of a written request from the plan or plan sponsor.

Premium information is not required, but can be added at the end of the SBC form.

*This mandate DOES NOT apply to:

  • Health Savings Accounts (HSAs);
  • Flexible Spendaing Accounts (FSAs) to the extent they are excepted benefits;
  • Standalone dental and/or vision plans;
  • Certified retiree-only plans

Please contact BCG at 800.766.3150 with any questions you may have.

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2012 SERVICE CONTRACT ACT HEALTH AND WELFARE FRINGE BENEFIT CHANGES

Beginning June 17, 2012 the prevailing health and welfare fringe benefits issued under the McNamara-O’Hara Service Contract Act (SCA) will be increased.

The employee-by-employee benefit will be increasing from $3.59 to $3.71 per hour, or $140.48 per week, or $643.07 per month. Also the average cost fringe benefit will be $3.71 per hour. The average cost fringe benefit wage determination will be issued only for those contracts where the formerly grandfathered “high” benefit rate would have applied.

Any and all invitations for bids opened, or other service contracts awarded on or after June 17, 2012 must contain an updated SCA WD issued in agreement with the regulatory health and welfare fringe benefit determination method. Contracting agencies may make pen and ink changes to their existing WDs received for contracts starting on or after June 17, 2012, and for those which did not include the updated health and welfare rates. It is not mandatory that contracting agencies request an updated WD for a health and welfare rate change. Revised WDs which include the new benefit rates will be available at the Wage Determinations Online website (www.wdol.gov) after June 17, 2012.

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Current News Letter  (September 2012)

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