Blues Following Summary of Benefits and Coverage Mandate

As part of the federal Affordable Care Act, health carriers and group health plans are now required to provide current and prospective members with a Summary of Benefits and Coverage.

Beginning Sept. 23, 2012, BCBSM and BCN intend to provide the Summary of Benefits and Coverage to individual members and to group customers that request them. The federal government has issued guidance to insurers by providing a form template and detailed rules on the format and content of the SBC.

Underwritten groups and SBC distribution

BCBSM and BCN will create and deliver SBCs to fully insured group customers and will have a joint responsibility with the group to distribute the document to the member.

BCBSM responsibilities to underwritten groups

Blue Cross will make the SBCs available to underwritten group health plans when they log in to Group Secured Services and for their employees through Member Secured Services at bcbsm.com.

You’ll also be able to access your clients’ SBCs by logging in to Agent Secured Services at bcbsm.com. Groups, agents and members will need to register for their particular secured site by visiting bcbsm.com and clicking on the applicable tab to begin the registration process. SBCs will be updated as required and posted to the secured sites.

Groups will be asked to notify their employees when their SBC is available based on the triggering event, as required by the ACA guidelines. The group may also reach out to its agent to assist them in obtaining and delivering the SBC, with you acting on behalf of your client.

If a group reaches out to you and asks for assistance with distributing the SBC, you’ll have four actions to choose from (these are applicable to BCBSM only):

1. Retrieve the SBC for the group by logging in to Agent Secured Services.
2. Instruct the group on how it can access its SBC by logging in to Group Secured Services.
3. Work with the group’s Blues representative to obtain the SBC.
4. For BCBSM groups without an assigned Blues representative, you can contact Account Services at AcctSvcsSBC@bcbsm.com.

We’ll be updating our rating tools, including RateEase and eQuoting, so they can be used to create SBCs for standard menu options. When using these tools, you’ll be expected to deliver the SBC along with the quote. When quoting benefit designs that aren’t standard menu options, you can work with your client’s Blues representative to obtain the SBC for them.

BCN responsibilities to underwritten groups

BCN won’t have the SBCs posted on Group or Agent Secured Services at this time. If a group asks you to retrieve its SBC, you must use Rate Ease or eQuoting to do so. If these tools aren’t available, email Field Services at BCNSBCRequests@bcbsm.com and request a copy of the SBC. Be sure to include in the request the group name, group number and email or regular mailing address.

Although BCN won’t post SBCs on the secured sites at this time, we’re working to implement a process that will do so in the future. We’ll update you as soon as more details become available.

Additional information concerning distribution of the SBC to BCBSM and BCN underwritten groups will be provided during agent training this fall.

ASC assistance

In contrast to underwritten groups, self-funded group health plans are solely responsible under the regulations for creating and providing SBCs, similar to responsibilities associated with other government-mandated plan documents such as the Summary Plan Description for ERISA groups.

We’ll provide ASC groups with a draft SBC template for BCBSM and BCN-administered coverage only. The draft template will be posted on Agent Secured Services and Group Secured Services. A detailed disclaimer will accompany the draft SBC template. Upon request, BCBSM and BCN will send the draft SBC template directly to the group.

BCBSM and BCN assume no responsibility for SBC rule compliance for our groups. The SBC rules are subject to some interpretation with respect to formatting and content requirements. The group may also have special situations such as account-based arrangements, carve-out coverage, or wellness programs. Therefore, the draft template may not be fully compliant with the SBC requirements for the group’s circumstances if the group interprets the rules differently or if it has special situations that may apply.

The draft template is populated only with benefit information for coverage administered by BCBSM or BCN. The group will remain solely responsible for completing the template and ensuring that its content and format are fully compliant with legal requirements. The group is also solely responsible for distributing the SBC as may be required under the rules.

Any assistance we provide will begin Sept. 23, 2012. SBCs won’t be posted on Member Secured Services for ASC groups.

ASC groups will also need to consult with their legal counsel and independently assess whether additional special circumstances and other plan documents and information, including carve-out benefits, might affect the content of their SBC. The government has recently provided an online calculator to help groups complete the Coverage Examples section of the SBC, along with a sample template and instructions for completing the document.

Individual business and SBC distribution

BCBSM and BCN will create and deliver SBCs for all individual customers. If you sell MyBlueSM individual products, note these updates in relation to the delivery of the SBC in these situations:

• At application – A legal disclaimer will appear above the signature on all paper and electronic applications. The disclaimer advises the applicant that the SBC isn’t a contract and includes other information such as how to obtain an electronic copy of the SBC on bcbsm.com and how to request a print copy of the summary. You won’t need additional direction, but you must begin inputting your client’s email addresses in the application, not your own.
• On request – Call 1-800-788-7334 and request an SBC on behalf of your clients. You must provide the customer’s name, address and the plan and deductible for which they’re requesting an SBC.
• The Blues will continue to provide updates concerning the SBC as more information becomes available. In the meantime, here’s an updated the FAQ (PDF) to reflect the latest developments.

Questions? Contact your managing agent.