SUMMARY OF BENEFITS AND COVERAGE

Toolkit for employers

June, 2012

CIGNA’S TOOLKIT WILL HELP YOU PREPARE

• 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

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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

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© 2012 Cigna

Toolkit ContentsToolkit Contents

OVERVIEW: SUMMARY OF BENEFITS AND COVERAGE

Provide individuals with HHS-defined standard information to compare plans and make decisionsProvide individuals with HHS-defined standard information to compare plans and make decisions

Required for insured and self-insured medical plans

Not required for retiree-only, Medicare, stand-alone dental/vision

Required for insured and self-insured medical plans

Not required for retiree-only, Medicare, stand-alone dental/vision

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Glossary Customer

Service # and Website

CoverageExamples

Four-Page Benefit Summaries &&

Intent:

Impact:

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

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

Effective:

$1,000 per enrollee per violation for “willful” non-compliance

Allowance made for first year for “good faith” efforts

$1,000 per enrollee per violation for “willful” non-compliance

Allowance made for first year for “good faith” efforts

Penalty:

FINAL RULE ISSUED FEBRUARY 9, 2012

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Feature Final Rule

Versions • 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 • May be combined with other materials, but must be prominent

© 2012 Cigna

WHEN SBCs MUST BE PROVIDED TO EMPLOYEES

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Situation Trigger Timing Requirements

Annual enrollment

• Enrollment periods beginning on or after September 23, 2012

• Active enrollment/Manual renewal: With open enrollment materials

• Passive enrollment/Automatic renewal: 30 days prior to first day of plan year

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

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Plan Year:New or

Renewal

Open Enrollment (OE) Period

SBC during OE?

SBC for New Hire/ Special Enrollment

11/1/12

1/1/13 or later

9/1/12 to 9/25/12

10/1/12 to 10/25/12

No

Yes

10/1/12 8/1/12 to 8/25/12 No 10/1/12 or later

11/1/12 or later

1/1/13 or later

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9/1/12 8/15/12 to 8/31/12 No 9/1/13 or later

COMPLIANCE/LOGISTICS: DISTRIBUTION EXAMPLES

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna

WHAT IF YOU MAKE A BENEFIT CHANGE AFTER YOU HAVE ALREADY PROVIDED THE SBC?

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Modified before

first day of plan

year

SBC had been

provided with OE

Reissue SBC by

the date coverage is

effective

Modified before

first day of plan

year

SBC had been

provided with OE

© 2012 Cigna

ROLES AND RESPONSIBILITIES

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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

OVERVIEW: MANDATORY SBC TEMPLATE – PAGE 1

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http://www.dol.gov/ebsa/pdf/CorrectedSampleCompletedSBC.pdfhttp://www.dol.gov/ebsa/pdf/CorrectedSampleCompletedSBC.pdf

© 2012 Cigna

OVERVIEW: MANDATORY SBC TEMPLATE, PAGE 7

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http://www.dol.gov/ebsa/pdf/CorrectedSampleCompletedSBC.pdfhttp://www.dol.gov/ebsa/pdf/CorrectedSampleCompletedSBC.pdf

© 2012 Cigna

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

• Updated anytime there is a significant benefit change

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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 co-insurance

– Available on your own intranet and/or on http://cciio.cms.gov/resources/other/index.html#sbcug

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14© 2012 Cigna

15© 2012 Cigna

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17© 2012 Cigna

EMPLOYEE ANNOUNCEMENT – BOILERPLATE COPY

• The attached Word document contains sample language that you can use in an employee email, benefit newsletter article or enrollment materials – both in English and in Spanish.

Employee Messaging - English

Employee Messaging - Spanish

Employee Messaging - English

Employee Messaging - English

Employee Messaging - Spanish

Employee Messaging - Spanish

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