Short answer: Yes. Providing an inaccurate, incomplete, or outdated SBC can result in penalties of up to $1,000 per affected individual, per violation, and may trigger federal enforcement actions.
Federal law requires Summary of Benefits and Coverage (SBC) documents to be accurate, complete, and current. An SBC that contains incorrect information, omits required content, or fails to reflect current plan terms is treated as a compliance failure.
Under the Affordable Care Act, penalties of up to $1,000 per affected individual, per violation may be assessed for noncompliance with SBC requirements, including providing inaccurate or misleading information. These penalties are subject to inflation adjustments and may apply separately to each participant or beneficiary impacted.
Enforcement authority is shared by the U.S. Department of Labor and the Internal Revenue Service. Violations may be identified through employee complaints, regulatory audits, or broader reviews of Affordable Care Act compliance.
Responsibility for SBC accuracy depends on plan type. For fully insured plans, insurers are generally responsible for preparing the SBC, while employers are responsible for proper distribution. For self-funded plans, employers are responsible for both preparation and distribution. Errors in an SBC may result in enforcement against the party legally responsible for that obligation, regardless of whether third parties assisted in preparing the document.
Sources
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Centers for Medicare & Medicaid Services, Summary of Benefits and Coverage (SBC)
https://www.cms.gov/cciio/resources/forms-reports-and-other-resources/summary-of-benefits-and-coverage -
Affordable Care Act, Section 2715
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26 U.S. Code §4980D
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29 CFR §2590.715-2715
Content history
Originally published: June 16, 2025
Last reviewed: January 25, 2026