Must a “Summary of Benefits and Coverage” be provided for a health FSA?


You know that group health plans will soon need to provide a Summary of Benefits and Coverage (SBC) to participants, but are confused about which plans the requirement applies to. Does an SBC need to be provided with respect to all group health plans, including certain account-type arrangements such as health flexible spending arrangements (health FSAs)?


An SBC does not need to be provided for plans, policies, or benefit packages that constitute excepted benefits. Thus, for example, an SBC does not need to be provided for standalone dental or vision plans or health FSAs if they constitute excepted benefits under governing regulations.

If benefits under a health FSA do not constitute excepted benefits, the health FSA is a group health plan generally subject to the SBC requirements. For a health FSA that does not meet the criteria for excepted benefits and that is integrated with other major medical coverage, the SBC is prepared for the other major medical coverage, and the effects of the health FSA can be denoted in the appropriate spaces on the SBC for deductibles, copayments, coinsurance, and benefits otherwise not covered by the major medical coverage.

A standalone health FSA must satisfy the SBC requirements independently.

The requirements to provide an SBC apply for disclosures to participants and beneficiaries who enroll or re-enroll in group health coverage through an open enrollment period (including re-enrollees and late enrollees) beginning on the first day of the first open enrollment period that begins on or after September 23, 2012.

Source: 77 FR 8668, February 14, 2012.

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