More Clarification Released on the Summary of Benefits and Coverage (SBC) and Uniform Glossary of Terms

03/22/2012

The Summary of Benefits and Coverage (SBC) rules were finalized in February of 2012. After a brief delay, the Departments have indicated the effective date that these disclosures must be distributed. “For group health plan coverage, the regulations provide that, for disclosures with respect to participants and beneficiaries who enroll or re-enroll through an open enrollment period (including late enrollees and re-enrollees), the SBC must be provided beginning on the first day of the first open enrollment period that begins on or after September 23, 2012. For disclosures with respect to participants and beneficiaries who enroll in coverage other than through an open enrollment period (including individuals who are newly eligible for coverage and special enrollees), the SBC must be provided beginning on the first day of the first plan year that begins on or after September 23, 2012. For disclosures from issuers to group health plans, and with respect to individual market coverage, the SBC must be provided beginning September 23, 2012.

Further, the Departments have stated that during this first year of applicability, the Departments will not impose penalties on plans and issuers that are working diligently and in good faith to provide the required SBC content in an appearance that is consistent with the final regulations. The Departments intend to work with stakeholders over time to achieve maximum uniformity for consumers and certainty for the regulated community.

Under the Affordable Care Act, health insurers and group health plans will be required to provide members with clear, consistent and comparable information about their health plan benefits and coverage. The regulations will ensure consumers have access to two forms that will help them understand and evaluate their health insurance choices. The forms include:

  • An easy-to-understand Summary of Benefits and Coverage (SBC), and
  • A Uniform Glossary of Terms commonly used to describe health insurance coverage components such as “deductible” and “co-payment”

See below for links to the most recent set of Frequently Asked Questions released by the DOL, a link to fact sheets published by Healthcare.gov., and a link to the SBC template.

FAQs: http://www.dol.gov/ebsa/faqs/faq-aca8.html

Fact Sheet: http://www.healthcare.gov/news/factsheets/2011/08/labels08172011a.html

SBC Template: http://cciio.cms.gov/resources/files/Files2/02102012/blank-sbc-template-finalpdf.pdf