Benefit Documents Explained
Summary of Benefits (SBC)
- What is it? An SBC is a summary about a medical health plan's benefits and coverage. It lists what the plan covers and what you pay for covered services. Insurance carriers are required to provide an SBC for any job-based health plan. All SBCs have the same format.
- Where can I find it? SBCs may be included in your renewal packet, downloaded from your insurance carrier's website or requested from your broker.
- When do I need it? Employees can download this to compare benefits before enrolling in a plan. After open enrollment, SBCs are available in the Medical Insurance app on the employee dashboard for reference throughout the year.
- What is it? Plan summaries are like SBCs because they also explain what an insurance plan covers and what you pay for covered services. However, unlike SBCs, plan summaries are not standardized and will look different for each carrier. These are used for dental, vision, group life, voluntary life, short term disability and long term disability plans.
- Where can I find it? Plan summaries may be included in your renewal packet or requested from your broker.
- When do I need it? Employees can download this to compare benefits before enrolling in a plan. After open enrollment, plan summaries can be found in the employee dashboard for reference throughout the year.
- What is it? An Excel document, PDF, or other that lists the cost of an insurance plan.
- Where can I find it? Rate sheets are typically included in renewal packets. For new plans, you can use the sold quote from the carrier.
Evidence of Insurability (EOI)
- What is it? This can also be referred to as a Statement of Health. The majority of Life & Disability plans require employees to submit an EOI if they enroll in coverage above a certain amount (guaranteed issue), or if they enroll in the plan outside of open enrollment.
- Where can I find it? EOIs can be requested from your insurance carrier, broker, or be downloaded from your insurance carrier's website.
Employer Contribution to Employee Premiums
- What is it? Most often, this is an Excel sheet or PDF created by the benefits administrator or broker that lists the employee cost and the employer cost. Employer contribution can be defined as a percentage or dollar amount.
Renewal Information Explained
Waiting Period: the length of time that employees must work at a company before their coverage is effective.
Termination Policy: when terminated employees are removed from the group insurance plan, which can either be the same day or the last day of that month.
Plan Mapping: determines which plan the employee will be auto enrolled in if they do not participate in open enrollment. Insurance carriers typically "map" or auto enroll employees to a new plan. This prevents employees from being terminated from the insurance plan unknowingly. We recommend matching the insurance carrier's plan mapping. Depending on the type of open enrollment, this can be one of the following situations:
- Same carrier, same plans: in most cases, the current year's plan should be mapped to the same plan for the upcoming year.
- Same carrier, new plans: the current year's plan should be mapped to the plan most similar for the upcoming year, or set to "Do not auto renew."
Selecting your open enrollment start and end date
Here are a few things to keep in mind when determining when to begin and end open enrollment.
- How long do your employees need to participate in open enrollment? Some employers have found that shorter open enrollment is most effective for increasing participation since it helps prevent procrastination. Other employers choose a longer open enrollment period. We recommend an open enrollment of anywhere from 1-4 weeks. The start time selected will determine when employees will receive the Open Enrollment email, inviting them to participate (in Pacific Time).
- Does your insurance carrier have a lead time? Some insurance carriers have a lead time, or deadline, for submitting plan changes. You'll want to be sure to end open enrollment with enough time to submit plan changes before the carrier deadline.
- Are you switching insurance carriers? If you're switching to a new carrier or offering new plans for the first time, you'll want to give yourself some extra time after open enrollment ends so that employee enrollments can be processed by the insurance carrier in time for employees to receive their new insurance information before the effective date.