Summary of Benefits and Coverage (SBC)
As part of President Obama's Affordable Care Act, Summary of Benefit and Coverage is a concise document detailing, in plain language, simple and consistent information about City health insurance benefits and coverage to help consumers better understand the coverage they have and allow one to easily compare different coverage options.
SBC's make it easier for consumers to find the best coverage for themselves and their families by summarizing the key features of each plan offered by the City, such as covered benefits, cost-sharing provisions, and coverage limitations and exceptions. SBC's include a standardized health plan comparison tool for consumers known as "coverage examples" using a format modeled on the Nutrition Facts label required for packaged foods. The "coverage examples" illustrate, for comparison purposes, what the plan would generally cover in two common medical situations.
SBC's standardized and easy to understand information about health plan benefits and coverage allows one to more easily make "apple to apples" comparisons among the health plans offered by the City of Newport. SBS's for July 1, 2017 include:
(*plan enrollees may also include eligible City retirees from both union and non-union groups)
The Affordable Care Act requires most people to have health care coverage that qualifies as "minimum essential coverage".
All City plans indicated above do provide minimum essential coverage.
The Affordable Care Act establishes a minimum value standard of benefits of a health plan. The minimum value standard is 60 percent (actuarial value).
All City health coverage indicated above do meet the minimum value standard for the benefits it provides.
Healthcare for Seasonal & Part Time Employees
Beginning in 2014, the Affordable Care Act (ACA) requires “large” employers, such as the City of Newport, to offer their full-time employees healthcare coverage that meets certain standards or pay a penalty. Full-time City employees are ones who are employed on average at least 30 hours per week (equates to 130 hours per month). An employee’s hours of service include: (1) each hour for which an employee is paid, or entitled to payment, to perform duties for the employer; and (2) each hour of paid leave.
In meeting this mandate, the City of Newport offers its seasonal and part time employees (who are deemed full time employees under ACA) with an optional health plan meeting the ACA’s definition of “minimum essential coverage”.
Questions, plan enrollment and plan premiums may be obtained by calling the Human Resources department at 401-845-5444.
ACA - Reporting Requirement - IRS FORM 1095-C
Did you receive Form 1095-C? - Click on image for more information
What is the Health Insurance Marketplace?
The Marketplace is a new way to find quality health coverage. It can help if you don’t have coverage now or if you have it but want to look at other options.
With one Marketplace application, you can learn if you can get lower costs based on your income, compare your coverage options side-by-side, and enroll.
What you'll learn when you apply in the Health Insurance Marketplace?
When you use the Health Insurance Marketplace, you'll fill out an application and see all the health plans available in your area. You'll provide some information about your household size and income to find out if you can get lower costs on your monthly premiums for private insurance plans. You'll learn if you qualify for lower out-of-pocket costs.
The Marketplace will also tell you if you qualify for free or low-cost coverage available through Medicaid or the Children's Health Insurance Program (CHIP).
The Health Insurance Marketplace is sometimes known as the health insurance "exchange” and most Americans will be eligible to use the Marketplace.
Apply online, by mail, or in-person?
You can apply for Marketplace coverage three ways: online, by mail, or in-person with the help of a Navigator or other qualified helper. Telephone help and online chat are available 24/7 to help you complete your application.
What plans in the Marketplace Cover?
Insurance plans in the Marketplace are offered by private companies. They cover the same core set of benefits called essential health benefits. No plan can turn you away or charge you more because you have an illness or medical condition. They must cover treatments for these conditions. Plans can't charge women more than men for the same plan. Many preventive services are covered at no cost to you.
Guidance on Marketplace Enrollment
- Open Enrollment Individuals may enroll in a qualified health plan through the Marketplace during the annual open enrollment period. (For coverage starting in 2017, the open enrollment period will begin on November 1, 2016 and run through January 31, 2017.)
- Special Enrollment Individuals may “specially enroll” in a qualified health plan through the Marketplace when they are initially eligible for COBRA due to a loss of other minimum essential coverage, including employer-sponsored coverage, or they have exhausted COBRA coverage. Special enrollment is not permitted merely because an individual stops paying COBRA premiums and loses COBRA coverage as a result.
Who runs the Marketplace in Rhode Island?
While all insurance plans are offered by private companies, the Marketplace is run by either the state or the federal government. If you live in Rhode Island, the Marketplace will be run by HealthSource RI. Instead of HealthCare.gov, you’ll use HealthSource RI website to apply for coverage, compare plans, and enroll.
Click here to visit HealthSoure RI now to learn more.
How the Marketplace presents plan information
The Marketplace simplifies your search for health coverage by gathering the options available in your area in one place. You can compare plans based on price, benefits, and other features important to you before you make a choice. Plans will be presented in four categories - bronze, silver, gold, and platinum to make comparing them easier.
In the Marketplace, information about prices and benefits will be written in simple language. You get a clear picture of what premiums you'd pay and what benefits and protections you'd get before you enroll. Compare plans based on what's important to you, and choose the combination of price and coverage that fits your needs and budget.
Call 1-800-318-2596, 24 hours a day, 7 days a week