Departments Finalize New Version of the SBC

The Department of Health and Human Services (HHS), the Department of Labor (DOL) and the Department of the Treasury have announced changes to the Summary of Benefits and Coverage (SBC) template and Uniform Glossary.

The modifications include an additional coverage example and language and terms intended to improve consumers’ understanding of their health coverage.

Under the Affordable Care Act, health plans are required to provide a brief summary of what the plan covers and the cost sharing responsibility of the consumer. Plans are also required to provide a comprehensive uniform glossary of commonly used health coverage and medical terms.

The SBC includes coverage examples that demonstrate the cost sharing amounts an individual might be responsible for in three common medical situations. In addition to the current coverage examples that address diabetes care and childbirth, the updated template has a new coverage example that addresses coverage for a foot fracture so that a consumer understands what a plan covers in an emergency scenario.

Changes have also been made to the SBC that are intended to improve readability for consumers. The new templates include more information about cost sharing, such as enhanced language to explain deductibles and a requirement that plans address individual and overall out-of-pocket limits in the SBC. These changes reflect input from consumer groups, the National Association of Insurance Commissioners and other stakeholders.

Health plans will use this final SBC template beginning on the first day of the first open enrollment period that begins on or after April 1, 2017.

Further information regarding the SBC and supporting materials can be found here.

About John Garner

John Garner has over thirty five years of experience in employee benefits. He specializes in compliance, health care reform, the Health Insurance Portability and Accountability Act (HIPAA), the Consolidated Omnibus Budget Reconciliation Act (COBRA), and the Employee Retirement Income Security Act (ERISA). He helps clients with life, health, and disability benefits, cost containment, flexible benefits, and claim consulting.

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