Distribution of 2025 Summary of Benefits and Coverage Notice to New Employees
October 10, 2024
Circular Letter: 600-046-24
Topic: Health Benefits
To: All Health Benefits Officers and Assistant Health Benefits Officers
Purpose
The purpose of this Circular Letter is to inform you about the requirement to distribute the attached 2025 Summary of Benefits and Coverage (SBC). Federal law requires you to send this notice to each new employee on the date they become eligible to enroll in a California Public Employees’ Retirement System (CalPERS) health plan. This distribution requirement is consistent with section 2715 of the Affordable Care Act (ACA) and corresponding regulations.1
Background
Under the ACA, persons who receive private health care insurance, such as those employed by CalPERS contracting agencies and schools, state agencies, and the California State University system, must have access to health plan SBCs and the glossary. Accordingly, the federal government has issued regulatory guidance, frequently asked questions, and templates relating to the matter. In the 2015 final rule, the federal government set forth that failure to provide the SBCs and glossary could result in a $1,000 penalty per offense.2
Summary of Benefits and Coverage Notice
CalPERS updates the SBC notice annually and provides information on how to access CalPERS health plans’ SBCs, as well as the federal government’s glossary of common health insurance terms. These tools help your employees better understand and compare their health plan options to make more informed choices. The SBC notice provides websites and phone numbers for all CalPERS health plans where newly eligible employees can access the SBCs and glossary. The SBCs and glossary are also available in the Forms & Publications section on our website.
The updated SBC notice will also be available in the Public Agency & Schools Health Benefits Guide (PDF) and the State Health Benefits Guide (PDF) starting January 2025.
Distribution Requirement
New employees not already enrolled in a CalPERS health plan must receive the attached 2025 SBC notice on the date they become eligible for enrollment, which is typically, for most but not all, the first day of employment.3 As an employer, federal law requires you to provide new employees the SBC notice as an electronic file or hard copy as part of your agency’s new hire or newly eligible benefit package.
Additional Resources
For final regulations and additional information about SBC requirements, visit the U.S. Department of Labor website.
Questions
If you have questions, call our CalPERS Customer Contact Center at 888 CalPERS (or 888-225-7377888-225-7377).
Yesenia Croft, Chief
Health Account Management Division
Attachment: 2025 Summary of Benefits and Coverage Notice Template (PDF)
- 1CalPERS continues to assess laws and regulations related to ACA. These letters are informational only and general in nature with respect to the ACA, and this Circular Letter does not constitute ACA-related legal advice. For legal advice regarding the ACA, consult your organization’s legal counsel.
- 245 Code of Federal Regulations 147.200(e).
- 345 Code of Federal Regulations 147.200(a)(ii)(B).