Health Care Reform Establishes New Requirements for Summary of Benefits
Monday, February 13 2012
Under health care reform, starting in September 2012, health insurers and health plans must provide a Summary of Benefits and Coverage (SBC) that meets specific guidelines to people who apply and enroll in health plans.
In developing the regulation, HHS stated that its aim is to help consumers understand and evaluate their health insurance choices by providing a “simple”, consistent document that outlines benefits and coverage in plain language. It may be provided in paper or electronic form under current ERISA electronic distribution rules.
• Standard glossary of medical and insurance terms
• Four page overview of plan benefits, cost sharing and limitations
• Standard set of examples of how the plan works
• A web address where the policy can be accessed
The rule requires that insurers and health plans provide a standardized SBC and Uniform Glossary to consumers when looking for coverage, enrolling in coverage, at each open enrollment / new plan year, and within seven business days of requesting a copy from their health insurance issuer or group health plan.
The rule applies to employees and dependents of domestic and international group and individual health plans. It applies to all fully insured and self-insured plans, regardless of grandfathered status. It does not apply to Medicare plans. For fully insured plans and HMOs, the insurer and the employer are responsible for producing and distributing the summaries. For self-insured plans, the responsibility lies with the employer.
We will continue to share information regarding how these regulations will be put into action as it becomes available.
