Common use of Summaries of Benefits and Coverage Clause in Contracts

Summaries of Benefits and Coverage. Under section 2715 of the Public Health Service Act, created by the Patient Protection and Affordable Care Act (the Affordable Care Act) and as implemented by summary of benefits and coverage regulations, certain employer groups and their employees who are eligible to enroll in, or who are enrolled in, the employer group’s health plan(s) are entitled to a Summary of Benefits and Coverage (and the uniform Glossary of Health Coverage and Medical Terms, which is available on the U.S. Departments of Labor and Health and Human Services Web sites as well as the Blue Cross and Blue Shield Web site) in certain circumstances on and after September 23, 2012. Blue Cross and Blue Shield will provide Summaries of Benefits and Coverage to you in accordance with the provisions described in this Agreement. You agree that Blue Cross and Blue Shield will not be responsible for providing Summaries of Benefits and Coverage to your employees. Blue Cross and Blue Shield Responsibilities For each of the Blue Cross and Blue Shield standard plan design(s) offered to your eligible employees under this Agreement, Blue Cross and Blue Shield will provide you with either a Web site address where you can obtain a copy of the standard Summary of Benefits and Coverage or, upon your request, a copy of the standard Summary of Benefits and Coverage in electronic (PDF) and/or printed format. Access to Summaries of Benefits and Coverage for standard plan designs will be available at least 60 days prior to your coverage effective date or your subsequent renewal date, or within seven business days of your request to Blue Cross and Blue Shield. In the event you have chosen to offer customized, non-standard Blue Cross and Blue Shield plan design(s) to your eligible employees under this Agreement, Blue Cross and Blue Shield will provide a copy of the Summary of Benefits and Coverage for each customized plan design to you in accordance with the Affordable Care Act and associated regulations. If there are changes that necessitate updating the Summary of Benefits and Coverage after it is provided to you, Blue Cross and Blue Shield will provide the updated Summary of Benefits and Coverage to you within seven business days of the change(s) being identified, but only when the requested changes reflect health care benefits provided by Blue Cross and Blue Shield. Generally, any Summary of Benefits and Coverage provided by Blue Cross and Blue Shield will describe only the health care benefits provided under this Agreement and will not describe health care benefits that are provided by another carrier, organization, or entity. Blue Cross and Blue Shield will not provide Summaries of Benefits and Coverage for senior plans (such as Managed Blue for Seniors, Medex, and Medicare Advantage plans) or for any standalone dental and/or vision plans. Your Responsibilities You will provide a complete Summary of Benefits and Coverage, along with the uniform Glossary of Health Coverage and Medical Terms to your employees as required by the Affordable Care Act and associated regulations. At the request of Blue Cross and Blue Shield, you agree to provide Blue Cross and Blue Shield with documentation to demonstrate compliance with these regulations. In the event you choose to offer customized, non-standard Blue Cross and Blue Shield plan design(s) to your eligible employees under this Agreement, you agree to provide sufficient information to Blue Cross and Blue Shield in the time required for Blue Cross and Blue Shield to provide a copy of the Summary of Benefits and Coverage in accordance with the Affordable Care Act and associated regulations. If you wish to request changes to the Summary of Benefits and Coverage provided to you by Blue Cross and Blue Shield, you must promptly notify Blue Cross and Blue Shield. You must inform Blue Cross and Blue Shield of the changes you are requesting to be made to the Summary of Benefits and Coverage to reflect the Blue Cross and Blue Shield health care benefits provided under this Agreement. If you do not promptly inform Blue Cross and Blue Shield of such changes, you will be solely responsible for satisfying all the requirements for issuing the Summary of Benefits and Coverage. In the event your group health plan is comprised of the plan design(s) offered under this Agreement plus one or more separate benefits plan(s) offered by a different carrier, organization, or entity, you will be responsible for combining, or arranging to have combined, the summary information into a single Summary of Benefits and Coverage or distributing multiple Summaries of Benefits and Coverage to each of your employees as required by the Affordable Care Act and associated regulations. You agree to indemnify and hold Blue Cross and Blue Shield harmless from any liability, damages, expenses, fees and costs, including but not limited to any attorneys’ fees or excise taxes, that may be imposed on, incurred by or assessed against you or Blue Cross and Blue Shield due to your failure to provide a complete and accurate Summary of Benefits and Coverage to each of your employees, in accordance with the Affordable Care Act and associated regulations.

Summaries of Benefits and Coverage. Under section 2715 of the Public Health Service Act, created by the Patient Protection and Affordable Care Act (the Affordable Care Act) and as implemented by summary of benefits and coverage regulations, certain employer groups and their employees who are eligible to enroll in, or who are enrolled in, the employer group’s health plan(s) are entitled to a Summary of Benefits and Coverage (and the uniform Glossary of Health Coverage and Medical Terms, which is available on the U.S. Departments of Labor and Health and Human Services Web sites as well as the Blue Cross and Blue Shield Web site) in certain circumstances on and after September 23, 2012. Blue Cross and Blue Shield will provide Summaries of Benefits and Coverage to you in accordance with the provisions described in this Agreement. You acknowledge and agree that Blue Cross and Blue Shield will not be responsible for providing Summaries of Benefits and Coverage to your employees. Blue Cross and Blue Shield Responsibilities For each of the Blue Cross and Blue Shield standard plan design(s) offered to your eligible employees under this Agreement, Blue Cross and Blue Shield will provide you with either a Web site address where you can obtain a copy of the standard Summary of Benefits and Coverage or, upon your request, a copy of the standard Summary of Benefits and Coverage in electronic (PDF) and/or printed format. Access to Summaries of Benefits and Coverage for standard plan designs will be available at least 60 days prior to your coverage effective date or your subsequent renewal date, or within seven business days of your request to Blue Cross and Blue Shield. In the event you have chosen to offer customized, non-standard Blue Cross and Blue Shield plan design(s) to your eligible employees under this Agreement, Blue Cross and Blue Shield will provide a copy of the Summary of Benefits and Coverage for each customized plan design to you in accordance with the Affordable Care Act and associated regulations. If there are changes that necessitate updating the Summary of Benefits and Coverage after it is provided to you, Blue Cross and Blue Shield will provide the updated Summary of Benefits and Coverage to you within seven business days of the change(s) being identified, but only when the requested changes reflect health care benefits provided by Blue Cross and Blue Shield. GenerallyYou acknowledge and agree that generally, any Summary of Benefits and Coverage provided by Blue Cross and Blue Shield will describe only the health care benefits provided under this Agreement and will not describe health care benefits that are provided by another carrier, organization, or entity. Blue Cross and Blue Shield will not provide Summaries of Benefits and Coverage for senior plans (such as Managed Blue for Seniors, Medex, and Medicare Advantage plans) or for any standalone dental and/or vision plans. Your Responsibilities You will provide a complete Summary of Benefits and Coverage, along with the uniform Glossary of Health Coverage and Medical Terms to your employees as required by the Affordable Care Act and associated regulations. At the request of Blue Cross and Blue Shield, you agree to provide Blue Cross and Blue Shield with documentation to demonstrate compliance with these regulations. In the event you choose to offer customized, non-standard Blue Cross and Blue Shield plan design(s) to your eligible employees under this Agreement, you agree to provide sufficient information to Blue Cross and Blue Shield in the time required for Blue Cross and Blue Shield to provide a copy of the Summary of Benefits and Coverage in accordance with the Affordable Care Act and associated regulations. If you wish to request changes to the Summary of Benefits and Coverage provided to you by Blue Cross and Blue Shield, you must promptly notify Blue Cross and Blue Shield. You must inform Blue Cross and Blue Shield of the changes you are requesting to be made to the Summary of Benefits and Coverage to reflect the Blue Cross and Blue Shield health care benefits provided under this Agreement. If you do not promptly inform Blue Cross and Blue Shield of such changes, you will be solely responsible for satisfying all the requirements for issuing the Summary of Benefits and Coverage. In the event your group health plan is comprised of the plan design(s) offered under this Agreement plus one or more separate benefits plan(s) offered by a different carrier, organization, or entity, you will be responsible for combining, or arranging to have combined, the summary information into a single Summary of Benefits and Coverage or distributing multiple Summaries of Benefits and Coverage to each of your employees as required by the Affordable Care Act and associated regulations. You agree to indemnify and hold Blue Cross and Blue Shield harmless from any liability, damages, expenses, fees and costs, including but not limited to any attorneys’ fees or excise taxes, that may be imposed on, incurred by or assessed against you or Blue Cross and Blue Shield due to your failure to provide a complete and accurate Summary of Benefits and Coverage to each of your employees, in accordance with the Affordable Care Act and associated regulations.