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Action Required: Summary of Benefits & Coverage Distribution

Aug 15, 2012

SBC Requirements under the Affordable Care Act
The Affordable Care Act mandates a new plan document entitled Summary of Benefits and Coverage.  You can view and download a new brochure that describes the SBC requirements and your distribution obligations. The SBC requirements are effective September 23, 2012, and include strict timeframes for the generation and distribution of the SBC. Penalties can apply for noncompliance.

The mandate applies to almost all self-funded and insured plans.The mandate DOES NOT apply to:
  • Health Savings Accounts (HSAs)
  • Flexible Spending Accounts (FSAs) to the extent they are excepted benefits
  • Standalone dental and/or vision plans
  • Certified retiree-only plans

You play a critical role in fostering compliance and avoiding fines and penalties
Aetna is legally responsible for the generation of all SBCs for insured plans. However, the plan sponsor shares responsibility with Aetna for delivering SBCs to members. Because of your role working with both Aetna and the plan sponsor, you will need to distribute the SBCs to your mutual customers in certain circumstances.

To retrieve the SBCs from the Producer World® website, go to, click on the link for Producers and then Producer Log In.

To make sure Aetna and your insured employers are compliant with this new requirement, Aetna will also monitor to ensure you are complying with these notification and distribution requirements. For more information about the SBC requirements and your distribution obligations, please click here to view and download the brochure.

Looking Forward
Aetna recognizes the important role that you play as an independent and trusted resource for customers who are making health insurance decisions. Aetna appreciates the support that you provide in educating and counseling customers about the SBC requirements, and other pertinent regulations of the Accountable Care Act (PPACA).

Please feel free to contact your b&p Group Sales Representative to discuss the details above - 888.722.3373.


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