Departments Issue Final Summary of Benefits and Coverage Regulations

Employers have a new health care reform deadline to add to their calendars. Last week, the Department of Health and Human Services (HHS), the Department of Labor (DOL), and the Department of the Treasury issued final regulations under the Patient Protection and Affordable Care Act that are intended to help:

  • individuals easily understand their health coverage and be able to pick their best coverage options; and
  • employers determine what the best coverage option is for their businesses and their employees.

Under these summary of benefits and coverage (SBC) requirements, consumers will have access to an “easy to understand” summary of benefits and coverage and a uniform glossary of terms that are frequently used in health insurance coverage (e.g., copayment and deductible).

Originally, under the proposed regulations, all health insurance issuers and group health plans would have had to provide consumers with summaries of benefits and coverage beginning March 23, 2012. However, the final regulations have changed the applicability date to September 23, 2012.

In addition to the final regulations, the departments also published helpful materials on the Employee Benefits Security Administration’s (EBISA) website. Such materials include a Guidance for Compliance document, an SBC template, a sample completed SBC, instructions for completing the SBC, HHS information for simulating coverage examples, and a uniform glossary of coverage and medical terms.

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