Final Regulations Issued on Summary of Benefits and Coverage

On Feb. 14, the Departments of Treasury, Labor and Health and Human Services (HHS) issued final regulations regarding the summary of benefits and coverage (SBC) and the uniform glossary for group health plans and health insurance coverage in the group and individual markets. The final regulations are effective April 16, 2012.  

Beginning on Sept. 23, health insurers and group health plans will begin providing the SBC and the uniform glossary to consumers.  According to a news release by HHS, the SBC will summarize the key features of the plan or coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions. The SBC will include a new, standardized health plan or policy comparison tool for consumers known as “coverage examples,” expected to be similar to the nutrition facts label required for packaged foods.  The uniform glossary includes a list of definitions that explain terms commonly used in health insurance coverage such as “deductible” and “co-payment.”  

On Oct. 21, 2011, ABC, along with 69 other companies and organizations, submitted comments addressing the notice of proposed rulemaking that would require all health plans and issuers to provide a summary of benefits and coverage and uniform glossary of terms.

In the comment letter, ABC and the other groups asked the U.S. Departments of Treasury, Labor and HHS to immediately assure employers that adequate time will be provided for compliance with these provisions. The groups also recommended a simpler approach to implementing the portion of the rules which call for plan participants to obtain “coverage facts labels” on selected health conditions.

In addition, the comments pointed out employers need flexibility not only to meet the requirements expected of them under the new law, but also to continue leading innovation in benefit designs that are highly valued, increase quality and contain costs.

“We urge the final rules be modified so they do not impose unnecessary expenses onto employer-sponsored health coverage,” the comments said. “Our ultimate goal is affordable, quality health care for our employees.”    

For more information, consult the following links: 

Guidance for compliance
SBC Template  
Sample completed SBC  
Further instructions and related materials  
HHS Fact Sheet