Ensure Your Employees Understand Their Health Care Coverage

Affordable Care Act (ACA) requirement for employers that sponsor group health plans

As required by the ACA, health plans and employer groups must provide the Summary of Benefits and Coverage (SBC)1 to eligible employees and family members, who are:

  • currently enrolled in the group health plan, or
  • eligible to enroll in the plan, but not yet enrolled, or
  • covered under COBRA Continuation coverage.

Health Net is committed to ensuring compliance with all timing and content

requirements with regard to the distribution of the SBC. To meet this goal, you are required to provide the SBC in the exact and unmodified form, including appearance and content, as provided to you by Health Net.

Please follow the instructions below so you will know how to distribute the SBC.

SBC form and manner

You may provide the SBC to eligible or covered individuals in paper or electronic form (i.e., email or Internet posting).

Timing of SBC distribution

Notice of SBC modification

Occasionally, there will be a material change(s) to the SBCs other than in connection with a renewal, such as changes in coverage. You must provide notice of the material changes to employees no later than 60 days prior to the date on which change(s) become effective. You must provide this notice in the same number, form and manner as described above. When such changes are initiated by Health Net, Health Net will provide you with modified SBCs for distribution.

Uniform glossary

Employees and family members can access a glossary of bolded terms used in the SBC by visiting www.cciio.cms.gov or by calling Health Net at the number on the ID card to request a copy. Health Net shall provide a written copy of the glossary to callers within seven business days after Health Net receives their request.

If you have any questions, please contact your Health Net client manager.

26 C.F.R. § 54.9815-2715; 29 C.F.R. § 2590.715-2715; and 45 C.F.R. § 147.200.

2 Such requirements can be found at 29 C.F.R. § 2520.104b-1(c).

3 Special enrollees are individuals who request coverage through special enrollment. Regulations regarding special enrollment are found in the U.S. Code of Federal Regulations, at 45 C.F.R. 146.117 and 26 C.F.R. 54.9801-6, and 29 C.F.R. 2590.701-6.