table that charts list of instruments
| Document Type |
Form No. |
Form Name |
Instrument File |
URL |
Available Electronically? |
Can Be Submitted Electronically? |
Electronic Capability |
| Other-SBC template-Nov 2019 |
|
|
SBC-Template-Standard-Format-11-2019.docx
|
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits |
Yes |
No |
Fillable Fileable |
| Instruction |
|
|
Group-Instructions-11-2019.pdf
|
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits |
Yes |
No |
Printable Only |
| Other-SBC Sample Glossary |
|
|
Uniform-Glossary-11-2019.pdf
|
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits |
Yes |
No |
Printable Only |
| Other-SBC Yes Answers -- Why This Matters |
|
|
Why-this-Matters-for-SBC-Yes-Answers-English-11-2019.pdf
|
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits |
Yes |
No |
Printable Only |
| Other-SBC - No Answers - Why This Matters |
|
|
Why-this-Matters-for-SBC-No-Answers-English-11-2019.pdf
|
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits |
Yes |
No |
Printable Only |
| Other-AIAN Limited Cost Sharing |
|
|
AIAN Limited Cost Sharing-11-2019.pdf
|
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits |
Yes |
No |
Printable Only |
| Other-AIAN Zero Cost Sharing |
|
|
AIAN-Zero-Cost-Sharing-11-2019.pdf
|
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits |
Yes |
No |
Printable Only |
| Other-Crosswalk of Changes |
|
|
Crosswalk-of-changes-11-2019.pdf
|
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits |
Yes |
No |
Printable Only |
| Instruction |
|
|
Individual-Instructions-11-2019.pdf
|
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits |
Yes |
No |
Printable Only |
| Other-List of Anchors |
|
|
List-of-Anchors-Updated-11-2019.xlsx
|
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits |
Yes |
No |
Printable Only |
| Other-Sample Completed- SBC Accessible Format |
|
|
Sample-Completed-SBC-Accessible-Format-11-2019.pdf
|
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits |
Yes |
No |
Printable Only |
| Other-Sample Completed- SBC Standard Format |
|
|
Sample-Completed-SBC-Standard-Format-11-2019.docx
|
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits |
Yes |
No |
Printable Only |
| Other-SBC Template Accessible Format |
|
|
SBC-Template-Accessible-Format-11-2019.pdf
|
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits |
Yes |
No |
Printable Only |
| Other-Template |
|
|
Having-a-Baby-Guide-11-2019.xlsx
|
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits |
Yes |
No |
Printable Only |
| Other-Template |
|
|
Managing-Type-2-Diabetes-Guide-11-2019.xlsx
|
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits |
Yes |
No |
Printable Only |
| Other-Template |
|
|
Simple-Fracture-Guide-11-2019.xlsx
|
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits |
Yes |
No |
Printable Only |
| Instruction |
|
|
Coverage-Examples-Calculator-Instructions-11-2019.pdf
|
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits |
Yes |
No |
Printable Only |
| Other-Narrative |
|
|
Maternity-Care-Narrative-11-2019.pdf
|
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits |
Yes |
No |
Printable Only |
| Other-Narrative |
|
|
Diabetes-Narrative-11-2019.pdf
|
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits |
Yes |
No |
Printable Only |
| Other-Narrative |
|
|
Foot-Fracture-Narrative-11-2019.pdf
|
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits |
Yes |
No |
Printable Only |
| Other-Coverage Calculator |
|
|
SBC-Coverage-Examples-Calculator-Excel-11-2019.xlsm
|
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/summary-of-benefits |
Yes |
No |
Fillable Printable |
