Agency Releases Final Rule for Standards for Mandated Summaries of Benefits and Coverage for Group Health Plans
The Department of Labor has just issued Final Rules on the PPACA mandate that sponsors of group health plans provide to eligible enrollees a summary of benefits and coverage scenarios of the plan. The summary must be brief and written in easy to understand language. Sponsors of plans are also required to provide a glossary of commonly used insurance terms.
The Final Rule requires plans sponsors to provide the summary and glossary at each new plan year, and within seven business days of requesting a copy from their health insurance issuer or group health plan.
The summary must also include coverage examples which will "illustrate how a health insurance policy or plan would cover care for common benefits scenarios. Using clear standards and guidelines provided by the Center for Consumer Information and Insurance Oversight (CCIIO), plans and issuers will simulate claims processing for each scenario so consumers can see an illustration of the coverage they get for their premium dollar under a plan."
Sponsors of plans will be required to provide the summaries and glossary for plan years beginning on or after 9/23/12.
The following are helpful links that can be used for complying with this mandate:
- Compliance Guide, available at www.dol.gov/ebsa/pdf/SBCguidance.pdf
- Summary of Benefits and Coverage Template, available at www.dol.gov/ebsa/pdf/SBCtemplate.pdf
- Sample Completed SBC, available at www.dol.gov/ebsa/pdf/SBCSampleCompleted.pdf
- Instructions for Completing the SBC - Group Health Plan Coverage, available at www.dol.gov/ebsa/pdf/SBCInstructionsGroup.pdf
- Instructions for Completing the SBC - Individual Health Insurance Coverage, available at www.dol.gov/ebsa/pdf/SBCInstructionsIndividual.pdf
- Why This Matters language for "Yes" Answers, available at www.dol.gov/ebsa/pdf/SBCYesAnswers.pdf
- Why This Matters language for "No" Answers, available at www.dol.gov/ebsa/pdf/SBCNoAnswers.pdf
- HHS Information for Simulating Coverage Examples, available at http://cciio.cms.gov/resources/other/index.html#sbcug
- Uniform Glossary of Coverage and Medical Terms, available at www.dol.gov/ebsa/pdf/SBCUniformGlossary.pdf
Get Involved in the Political Process! You may have seen SIIA's newly initiated "Member Grassroots Project". This will provide you the invaluable opportunity to help SIIA's government relations efforts. We encourage all SIIA members to consider participating in any or all of the various presented options. To learn more about this effort or to sign up, visit www.siia.org/grassroots or call 202/463-8161.
Join SIIA's Facebook Page! Make sure to visit and "like" SIIA's Facebook page to keep up-to-date with all the activities our Association is involved in and to interact with industry colleagues. You can access it by clicking HERE.