10
Availability of Summary
Health Information
As an employee, the health
benefits available to you represent
a significant component of your
compensation package. They also
provide important protection for
you and your family in case of
illness or injury.
Your plan offers a series of health
coverage options. Choosing a
health coverage option is an
important decision. To help you
make an informed choice, your
plan makes available a Summary
of Benefits and Coverage (SBC).
The SBC summarizes important
information about any health
coverage option in a standard
format to help you compare across
options.
The SBC is available online at:
<[group’s website.com]>. A paper
copy is also available, free of
charge, by calling the toll-free
number on your ID card.
Timing of SBC distribution
• Upon application. If you distribute
written application materials, you
must include the SBC with those
materials. If you do not distribute
written application materials for
enrollment, you must provide the
SBC by the first day the employee
is eligible to enroll in the plan.
• Special enrollees. For special
enrollees,
3
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.
you must provide the
SBCs within 90 days following
enrollment.
• Upon renewal. If open enrollment
materials are required for renewal,
you must provide the SBC no later
than the date on which the open
enrollment materials are distributed.
If renewal is automatic, you must
provide the SBC no later than
30 days prior to the first day of the
new plan year.
If your group health plan is renewed
less than 30 days prior to the
effective date, you must provide
the SBC as soon as practicable, but
no later than 7 business days after
issuance of new policy or the receipt
of written confirmation of intent to
renew your group health plan.
At the time your plan renews, you
are not required to provide the
HealthNet SBC to an employee
who is not currently enrolled in a
HealthNet plan. However, if an
employee requests a Health Net
SBC, you must provide the SBC as
soon as you can, but no later than
7 business days following your
receipt of the request.
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
HealthNet, HealthNet 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 HealthNet at the
number on the ID card to request a
copy. HealthNet shall provide a written
copy of the glossary to callers within
7 business days after HealthNet
receives their request.
If you have any questions, please
contact your HealthNet client
manager.
This document is provided to you as a customer courtesy and is not intended to be legal advice. Please consult with your own legal counsel to determine your responsibilities under the SBC regulations
of the Affordable Care Act.
Health Net of California, Inc. and Health Net Life Insurance Company are subsidiaries of Health Net, LLC. Health Net and Salud con Health Net are registered service marks of Health Net, LLC. All other
identified trademarks/service marks remain the property of their respective companies. All rights reserved.
FRM039979EC00_SBG_CA (1/21)
SBG GSA 1/21