With evolving regulations based on the Affordable Care Act, employers can no longer afford to solve compliance challenges at the document level.

The weeks and months leading up to open enrollment are already stressful and adding Summary of Benefits and Coverage (SBC) generation to the mix can make things even worse.

Failure to comply has the potential to be costly. SBCs must be distributed at initial enrollment (by the first date an individual can enroll in coverage), at open enrollment (no later than 30 days before the beginning of the next plan year), during HIPAA special enrollment (no later than 90 days after enrollment) and on request (no more than seven business days after a request).

Penalties for willful failures to provide an SBC to an individual or a plan participant or beneficiary are significant—now up to $1,087 for each failure (and that amount is subject to change annually). Excise taxes may also apply.

DirectPath manages benefits data, reducing the time, cost and errors associated with moving data through multiple silos. Plan designs are automatically reflected in SBCs, and can be used by a benefits administration vendor or platform for other compliance and/or open enrollment communications materials.

In fact, customers on average reduce the time spent creating SBCs by 70 percent, allowing staff to focus on core business functions—like effective open enrollment communications—rather than data entry.

The highly prescribed nature of SBCs is ideally suited to the application of technology. By automating SBC generation, DirectPath helps ensure accuracy, quality and fast turnaround.

Key Benefits to Working with DirectPath:

  • Automation ensures consistency and compliance
  • Data is centralized and accessible—key attributes for easy SBC generation—not “locked up” in discrete documents in multiple locations
  • Secure workflow environment for rule-based review and approval process
  • Application of the latest SBC template and requirements

Related Viewing: The Beauty of DirectPath: Being ACA and ERISA Compliant


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Championing Change: Managing the Evolving SBC Requires A Winning Strategy
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