Under the Affordable Care Act, group health plans, grandfathered and non-grandfathered, and health insurance issuers are required to provide a written Summary of Benefits and Coverage (“SBC”) to plan participants and beneficiaries at specified times during the enrollment process and upon request.
The SBC provides a summary of what the plan covers and the cost sharing responsibility of the consumer. They are intended to help health plan consumers better understand the coverage they have and to help make easy comparisons of different options when shopping for new coverage.
SBCs must be provided in a prescribed form. Form language and formatting must be precisely reproduced, unless instructions allow or instruct otherwise.
On April 6, 2016, the Department of Health and Human Services (HHS), the Department of Labor (DOL) and the Department of the Treasury issued the final revised template and related materials for the SBC.
The new SBC template includes an additional coverage example as well as language and terms to improve individuals’ understanding of their health coverage. Specifically, the new template includes more information about cost-sharing, such as enhanced language to explain deductibles, and requires plans to address individual and overall out-of-pocket limits. Changes have also been made to the SBC to improve readability.
Use of the new SBC template will be required starting with the first day of the first open enrollment period that begins on or after April 1, 2017, with respect to coverage for plan years beginning on or after that date.
Visit the U.S. Department of Labor’s webpage on the SBC and Uniform Glossary for the latest updates, and to access all available templates and related documents.
For more information on Affordable Care Act requirements, contact AssuredPartners NL’s Employee Benefits Team.Share This: