On December 30, 2014, the Departments of Health and Human Services, Labor and Treasury (the “Agencies”) jointly published a proposed rule amending the current Summary of Benefits and Coverage (“SBC”) regulation. 79 Fed. Reg. 78578. At the same time, the Agencies revised the SBC template; the sample completed SBC; the instructions for
completing the SBC applicable to group coverage and to individual coverage; the “Why This Matters” language template; the Coverage Examples; and the Uniform Glossary.
Comments are requested by March 2, 2015 on the proposed rule and the revised documents.
What Actions You Should Take
Group health plans and health insurance issuers should carefully review the proposed modifications to the SBC to determine how those modifications will change the plan or issuer’s compliance efforts. Note, particularly, that the Agencies propose to require plans and issuers to use these new templates for this fall’s open enrollment. As with the previous final SBC rule, given the complexity of the rule, and the potential for civil penalties, it is
important that plan sponsors and health insurance issuers to carefully evaluate the time and resources necessary to comply with the rule.
Comments are due March 2, so there is still time to share any thoughts or concerns you have with the proposed rule with the Agencies.
I. Background
The Patient Protection and Affordable Care Act (“ACA”) added section 2715 to the Public Health Service Act (“PHSA”) which requires group health plans and health plan issuers to compile and provide an SBC that “accurately describes the benefits and coverage under the applicable plan and coverage.”
The SBC requirement applies to insured and self-funded ERISA group health plans, including grandfathered plans, as well as to non-ERISA group health plans and individual health insurance coverage.
The SBC must follow a uniform format which includes a series of content requirements such as: uniform standard
definitions of medical and health coverage terms; a description of the coverage including the cost sharing
requirements (i.e. deductibles, coinsurance, and copayments); and information regarding any exceptions, reductions,
or limitations under the coverage. On August 22, 2011, the Agencies issued proposed regulations on 76 Fed. Reg.
52442 (Aug. 22, 2011); 76 Fed. Reg. 52475 (Aug. 22, 2011). The final regulations were published in the Federal
Register on February 14, 2012 and were effective on April 16, 2012. A summary of those final regulations is available at http://www.groom.com/resources-653.html.
Read the full article here.
Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.
