SBC - Anthem
SBC - Anthem
SBC - Anthem
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A quick guide to theSummary of Benefitsand Coverage (<strong>SBC</strong>) forIndividual brokersEverything you need to knowabout <strong>SBC</strong>sWhat does the health care reform law say about theSummary of Benefits and Coverage (<strong>SBC</strong>)? This guideprovides information on <strong>SBC</strong>s and how we are complyingwith the health care reform law. Summary of Benefits andCoverage (<strong>SBC</strong>)+ +◦ What does the health care reform lawsay about <strong>SBC</strong>s?◦ Providing consumers access to <strong>SBC</strong>s◦ The postcard◦ Translating <strong>SBC</strong>s◦ What an <strong>SBC</strong> looks like Finding an <strong>SBC</strong> online◦ How to access <strong>SBC</strong>s◦ Sending <strong>SBC</strong>s electronically31125CABENABC 08/12
Summary of Benefits and Coverage (<strong>SBC</strong>)What does the health care reform law say about <strong>SBC</strong>s?Effective September 23, 2012, the Affordable Care Act (or health care reform law) requires that all insurers provide<strong>SBC</strong>s to consumers when:◦ They are shopping for coverage.◦ Coverage changes.◦ The deductible resets.◦ Requested by an enrolled policyholder.<strong>SBC</strong> regulations state that <strong>SBC</strong>s do not need to be provided for “closed” plans until September 23, 2013.Closed plans are plans or products that we are no longer selling.The <strong>SBC</strong> helps members understand their benefits and coverage by using simple language anda consistent format. It includes:◦ A description of coverage◦ Examples of coverage◦ Appeals and grievance rights◦ Exclusions and limitations◦ Cost-sharing provisions, including the deductible, coinsurance and copays◦ Information on how to renew and continue coverage◦ A phone number to call for questions◦ A website where the consumer can access:- A uniform glossary and instructions on how to get a printed copy if desired- A list of network providers- An overview of prescription drug coverage, if applicableAs a broker, youhave no obligationto distribute an <strong>SBC</strong>to a consumer.2Providing consumers access to <strong>SBC</strong>sWhen shopping for coverage, consumers may access <strong>SBC</strong>s for comparison (if they choose) on healthcare.gov to helpthem select the coverage that best meets their needs.We’ve also added similar language (and a website link) to all pre-sales marketing materials to ensure consumers knowwhere to find the new health care reform <strong>SBC</strong>s.According to the regulation, access to an <strong>SBC</strong> must be provided to consumers when:◦ They apply for coverage and we receive an application. An <strong>SBC</strong> must be provided as soon as possible after wereceive an application, but no later than seven business days after we have the application.- To comply with this requirement, we will send a postcard to applicants within seven business days of getting theirapplication for coverage and then a notice with their ID card after their application is accepted. The informationin the notice with their ID card and on the postcard will direct them on how to obtain their <strong>SBC</strong> electronically orrequest a printed copy free of charge.◦ The annual deductible resets. Consumers will receive a postcard with information that directs them how to obtaintheir <strong>SBC</strong> electronically (or a printed copy) before each plan year so they can see how their coverage may be changing.◦ Coverage changes. If we make any significant changes in coverage (for example, to comply with a mandate),policyholders will be notified at least 60 days before the change takes effect.◦ They ask. An enrolled policyholder will be able to request an <strong>SBC</strong> at any time, and it must be provided by the healthinsurer within seven business days.
Scenarios for delivering <strong>SBC</strong>s to membersScenarioIs member entitled to an<strong>SBC</strong> in 2012?When is <strong>SBC</strong> distributed?Individual members: when deductible resets Yes At least 30 days before the deductible resets. For most individual members, thedeductible resets on January 1.Individual members: shopping Yes During the shopping experience, Individual members may see the <strong>SBC</strong> athealthcare.gov if they choose. Within seven business days of receiving anapplication, we will send Individual members a postcard with a URL that leadsthem directly to their <strong>SBC</strong>. They may also request a paper copy free of charge.The postcard◦ We will send a postcard to Individual applicants with a plan or policy-specific URL where they can access theplan’s <strong>SBC</strong>. The postcard also has a phone number to call if the policyholder would like to request a printedcopy free of charge.◦ Once enrolled, policyholders can access their <strong>SBC</strong> at a similar plan-specific URL and will be directed to theirplan-specific document in post-enrollment materials that come with their ID card.Translating <strong>SBC</strong>s◦ We are committed to meeting the <strong>SBC</strong> foreign language translation requirement that goes into effect onSeptember 23, 2012.◦ Federal agencies have translated the <strong>SBC</strong> template, sample language and the uniform glossary in Spanish,Tagalog, Chinese (traditional) and Navajo.◦ On request, we will translate an <strong>SBC</strong> to meet the culturally and linguistically appropriate (CLA) languageprovision. If at least 10% of a county’s population is fluent in a language other than English, we willtranslate an <strong>SBC</strong> into that language.◦ We will offer foreign language help outside of the 10% threshold in counties for the four mandatedlanguages (see above). This will include expanded language options to ensure compliance with all applicablestate mandates.What does an <strong>SBC</strong> look like?The Department of Labor has a sample<strong>SBC</strong> on its Affordable Care Act site.Click here to see a sample.3
Finding an <strong>SBC</strong> onlineAgents and brokers will have access to all <strong>SBC</strong>s and may look them up at anytime for referenceor to give to clients as a courtesy.Please note: As a broker, you have no obligation to distribute an <strong>SBC</strong> to a consumer.How to access <strong>SBC</strong>sGo to find-sbc.com and enter your client’s ZIP code.1. Follow the steps on the left side of the screen. Start by choosingthe second button: I am a sales professional or broker. Fromthe drop-down menu, select: I am looking for …Consumer Plans.Click Next.2. Follow instructions listed for steps 2 and 3(screenshots not shown).3. Check the box that says Skip directly to resultspage and click Next.4. Select the desired plan from the list andclick Download.Sending <strong>SBC</strong>s electronicallyAccording to the Department of Labor, with respect to individualcoverage, a health insurer must provide the <strong>SBC</strong> in either paper orelectronic form. To be provided electronically, the <strong>SBC</strong> must be:◦ In a format that is easy to access (such as a pdf file).◦ Easy to find when posted on a website.◦ Provided in an electronic form that can be saved and printed.◦ Available free of charge in hard copy when requestedby a consumer (the issuer must notify consumers aboutthis option).<strong>Anthem</strong> Blue Cross is the trade name of Blue Cross of California. <strong>Anthem</strong> Blue Cross and <strong>Anthem</strong> Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ®ANTHEM is a registered trademark of <strong>Anthem</strong> Insurance Companies, Inc. TheBlue Cross name and symbol are registered marks of the Blue Cross Association.