“SIMPLE, STRAIGHTFORWARD” SUMMARY OF HEALTH PLAN BENEFITS REQUIRED TO BE PROVIDED FOR COMPARING PLANS (04/11/2012)

The Departments of Health and Human Services, Labor and Treasury (Departments) released much-anticipated final guidance on the requirement for health plans and health insurance issuers to provide a summary of benefits and coverage to applicants and enrollees.

The health care reform law created the summary of benefits and coverage, or SBC, to provide consumers with simple and straightforward information on plan coverage in a uniform format. According to the Departments, the SBC will help consumers better understand the coverage they have and compare differences in benefits and coverage when they are shopping for a new plan. To implement this disclosure requirement, the Departments released final regulations outlining standards for preparing and providing the SBC. In addition to the final regulations, the Departments also provided a final template for the SBC (along with instructions, samples and a guide for the coverage example calculations to be included in the SBC) and the uniform glossary explaining terms commonly used in health coverage.

The final regulations, template and uniform glossary are available through the Department of Health and Human Services at: http://cciio.cms.gov/programs/consumer/summaryandglossary/index.html

Because final SBC guidance has now been released, plans and issuers must prepare to start providing the SBC by September.


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