©2022 Arthur J. Gallagher & Co. All rights reserved.
ERISA PLANS, CHURCH
PLANS, and FULLY-
INSURED NON-FEDERAL
GOVERNMENTAL PLANS
To Notify
Participants & Beneficiaries
who are…
Eligible but NOT enrolled
(e.g. New Hires), you may …
Covered under a
plan, you may …
Use Electronic Delivery IF ...
• SBC is created in format readily
accessible (such as HTML, MS Word, or
PDF)
• It includes an offer of a paper version
available upon request at no charge
- - - - - - - - - - - - - - - - - - - -
If Internet posting, you must also:
• Send timely notification to participants
and beneficiaries by email or postcard
(see “sample”), including Internet
address
Use Electronic Delivery IF …
• Participants and beneficiaries are notified
that documents are provided
electronically
• Significance of the SBC is explained
• Notification includes the availability of a
paper version upon request at no charge
• Receipt is ensured using “return-receipt,”
notice of undeliverable mail, or surveys
And for …
Employees with
Work-Related
Computer
Access
Employees with
Non Work-Related
Computer Access
Ensure access to the
electronic
information system is
an integral part of
their employment
duties.
Individual MUST “Opt-In”:
• Participant/Beneficiary consent is
required in a manner that
demonstrates access
Consent request must include:
• Type of document (SBC) to be
provided electronically
• Offer of a paper version available
upon request at no charge
• Procedure to withdraw consent
• Hardware/Software requirements
FEDERAL
GOVERNMENTAL PLANS
To notify
Participants &
“Eligible but not
enrolled,” follow the
same requirements
above OR
“Covered under a
plan,” follow the
same requirements
above OR …
SBC MUST be:
• In readily accessible format, placed in a prominent
location, available for printing/retaining electronically,
consistent with appearance, content and language
requirements, and available in paper version upon
request at no charge
AND the Plan chooses to ...
• Email SBC after receiving consent from participant and
beneficiaries
OR
•
Post to Internet and send timely notification to
participants and beneficiaries by email or postcard (see
“sample”), including internet address
Select your
type of
PLAN
“Sample” email/postcard notification:
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), which summarizes
important information about any health
coverage option in a standard format, to help
you compare across options.
The SBC is available on the web at:
www.sample.com. A paper copy is also
available, free of charge, by calling 1-xxx-xxx-
xxxx (a toll-free number).
See Page 3 for
Online Enrollment
Safe Harbor
Provide in connection
with online enrollment
or renewal OR
©2022 Arthur J. Gallagher & Co. All rights reserved.
Electronic Distribution Requirements for
Summary of Benefits and Coverage
If the Summary of Benefits and Coverage (SBC) will distributed electronically, the following
requirements must be met:
ERISA, Church, and Fully Insured Nonfederal Governmental Plans
(I) For participants and beneficiaries who are eligible but not enrolled in coverage, an
SBC may be provided electronically if:
• The format is readily accessible (such as in an HTML, MS Word, or PDF format);
• The SBC is provided in paper form free of charge upon request; and
• If the SBC is provided via an Internet posting, you must:
o Timely notify the individual in paper form (such as a postcard) or email that the
SBC documents are available on the Internet,
o Provide the Internet address, and
o Notify the individual that the documents are available in paper form upon
request.
(II) For participants and beneficiaries who are covered under a plan, an SBC may be
provided electronically if:
A. In accordance with the Department of Labor’s electronic disclosure regulations, the
safe harbor provisions listed below are followed:
• Employee and non-employee (e.g. COBRA Qualified Beneficiaries, employees on
FMLA leave, retirees) participants must be notified that the documents are being
provided electronically, the significance of the items being provided, and that they
may receive a paper copy of the document upon request;
• The SBC is provided in paper form free of charge upon request; and
• You ensure each participant has received the notification by using “return-receipt
email,” notice of undelivered mail, or by conducting periodic reviews or surveys to
confirm receipt. Email receipts should be printed out and filed with the plan’s copy
of the SBC.
©2022 Arthur J. Gallagher & Co. All rights reserved.
And, for participants with work-related computer access you must:
• Ensure participants can access the electronic document at their workstation where
access to the employer’s or plan sponsor’s electronic information system is an
integral part of their employment duties.
And, for participants with no work-related computer access, including employees,
COBRA Qualified Beneficiaries (or similar individuals on continuation coverage under
a church plan), employees on FMLA, and retirees, affirmative consent is required:
• The participant must consent electronically to receive the document electronically
and provide an email address.
• The participant’s consent must be obtained in a way that demonstrates the
participant can access the document via the method of electronic distribution. Prior
to giving consent, the participant must be informed of all the following:
o The type of document that will be provided electronically;
o That consent can be withdrawn at any time and the procedure for withdrawing
consent and/or updating information, such as an email address;
o The right to request and obtain a paper copy of the document; and
o The type of hardware and/or software needed to access and retain the
electronic document.
B. An additional safe harbor is available to plan sponsors, in the following circumstances:
• If the plan sponsor conducts enrollment or renewal/reenrollment online, SBCs may
be provided electronically to covered participants and beneficiaries in connection
with their enrollment.
• Plan sponsors may make SBCs available online for covered participants and
beneficiaries who request a copy of the SBC online.
In either case, the individual must have the option to receive a paper copy upon request.
©2022 Arthur J. Gallagher & Co. All rights reserved.
Self-Insured Non-Federal Governmental Plans
Choose to conform to either the provisions for ERISA Plans (described above) or the provisions
applicable to issuers offering individual health insurance coverage. The provisions for issuers
offering individual health insurance coverage include:
• Email the SBC after obtaining the participants or beneficiaries agreement to receive
the SBC or other disclosures by e-mail, or
• If disclosed via an Internet posting, notify the participant and beneficiaries by email or
postcard that the SBC is available on the Internet (including internet address).
o The SBC form may be provided electronically if:
The SBC format is readily accessible (such as in an HTML, MS
Word, or PDF format);
The SBC is placed in a location that is prominent and readily
accessible;
The SBC is provided in a format that can be electronically retained
and printed;
The SBC is consistent with appearance, content, and language
requirements; and
Notification is made to the participant or beneficiaries that a paper
form is available upon request at no charge.
The intent of this analysis is to provide general information regarding the provisions of current federal
laws and regulation. It does not necessarily fully address all your organization’s specific issues. It should
not be construed as, nor is it intended to provide, legal advice. Your organization’s general counsel or an
attorney who specializes in this practice area should address questions regarding specific issues.