SBC Requirements - HRA, FSA, and HSA

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SBC Requirements - HRA, FSA, and HSA

Health care reform imposes a summary of benefits and coverage (SBC) requirement on most group health plans beginning with (1) the first open enrollment period that begins on or after September 23, 2012, for individuals enrolling or re-enrolling through open enrollment; and (2) the first plan year that begins on or after that date, for enrollments occurring outside of open enrollment. Strict appearance, content, and language requirements apply, including the use of a prescribed SBC template.

Whether an SBC is required for a particular account-based arrangement generally depends on the type of arrangement and, in the case of a health FSA or HRA, whether it is an excepted benefit. “Excepted benefits” include, but are not limited to, health FSAs satisfying certain conditions (including a maximum benefit condition and a requirement that other nonexcepted group health plan coverage be available) and certain limited-scope dental and vision coverage. Retiree-only plans are also excepted.

  • Excepted Health FSAs and HRAs. An SBC is not required for excepted benefits, which include many health FSAs and certain HRAs. The sponsor of an excepted health FSA orHRA may nonetheless choose to describe the effects of its account-based plan in the SBC for the related major medical coverage.
  • Nonexcepted Health FSAs and HRAs. Information about health FSAs and HRAs that are not excepted benefits, but are “integrated” (a term that is not defined under the applicable guidance) with other major medical coverage, are subject to the SBC requirement but can be described in the appropriate spaces on the major medical SBC for deductibles, co-payments, co-insurance, and benefits otherwise not covered by the major medical coverage. (During the first year that SBCs are required, however, plan administrators can opt to either distribute a single integrated SBC or prepare a stand-alone version.) Stand-alone health FSAs and HRAs (i.e., non-integrated plans) that are not excepted benefits must satisfy the SBC requirement independently.
  • HSAs. Since HSAs are generally not group health plans, an SBC is not required for anHSA. However, an SBC does have to be provided for the high-deductible health plan (HDHP) that an employer must provide to make its employees HSA-eligible. An SBC prepared for an HDHP associated with an HSA can mention the effects of employer contributions to HSAs in the appropriate spaces on the SBC for deductibles, co-payments, co-insurance, and benefits otherwise not covered by the HDHP.

Satisfying the strict form and content rules for SBCs can be a challenge for account-based arrangements, as those rules were crafted with traditional health plans in mind. To the extent that benefits subject to the SBC requirement do not fit within the SBC template and cannot reasonably be described in a manner consistent with the template and instructions, best efforts must be used to provide the information in a manner that is still consistent with the template format and instructions.

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Last Modified:5/2/2014 12:29:01 PM

Last Modified By: Kevin_Murphy

Type: INFO

Level: Advanced

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