One of the most important insurance reforms imposed by the Affordable Care Act is a requirement that insurers and self-insured group health plans make available to applicants and enrollees a Summary of Benefits and Coverage (SBC) that concisely, uniformly, and accurately describes health plans that applicants are considering or in which enrollees are enrolled. The SBC allows shoppers to compare side-by-side plans that they are considering purchasing, and also helps enrollees understand their coverage once they are enrolled.
The ACA required the Departments of Labor, Treasury, and Health and Human Services, which are charged with implementing the SBC requirements, to consult with a stakeholder group convened by the National Association of Insurance Commissioners in drafting the SBC rule. The original final SBC rulewas not published until 2012, after recommendations were received from that body.
When the 2012 SBC rule was published, however, and again in the months following its publication, the departments released a series of frequently asked question which generally provided plans and insurers flexibility in complying with the requirements of the rule. In December of 2014, the departments published a proposed rule (covered here) to modify the original rule.
The proposed rule contained provisions governing how insurers and group health plans were to make SBCs available, as well as changes to the content of the SBC itself — the SBC template and instructions and uniform glossary of coverage terms.
Read the full report here.
Contact Steven G. Cosby, MHSA, Group Health Insurance Broker and Agent with Cosby Insurance Group, with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.
