August 7, 2012 – Medicare Advantage Plans and SBCs
On August 7, 2012, the DOL posted a new FAQ regarding the requirement to distribute summaries of benefits and coverage (“SBCs”). The FAQ addresses group Medicare Advantage plans (i.e., Medicare Part C). The FAQ may be viewed at http://www.dol.gov/ebsa/faqs/faq-aca10.html.
Note: Medicare Advantage plans are different than Medicare supplement plans. Medicare supplement plans are already exempt from the SBC requirement because they constitute HIPAA-excepted benefits.
The FAQ indicates that the regulatory agencies (DOL, IRS, and HHS) will not enforce the SBC requirement with respect to group Medicare Advantage plans. This non-enforcement position applies to group Medicare Advantage plans that do not qualify as stand-alone retiree-only plans, which are already exempt from the SBC requirements.
If you have any questions or would like assistance with compliance with the SBC requirements (e.g., identifying which group health plans are subject; preparing appropriate SBCs; determining delivery populations and methods; etc.), please contact us.
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The information contained in this ALERT is intended for general information purposes only and does not constitute legal advice relative to a specific situation.