The three government agencies responsible for the implementation of health care reform (Department of Health and Human Services, Department of Labor and Department of Treasury) today issued new rules expanding upon the requirement under the Affordable Care Act that health insurers and group health plans provide clear, consistent and comparable information about health plan benefits and coverage. Under the Affordable Care Act, insurers and group health plans are required to provide a four page Summary of Benefits and Coverage (SBC) along with a Uniform Glossary explaining terms commonly used in health plans. Proposed guidance issued in August 2011 provided a template for plans to use to create an SBC and Uniform Glossary and set a March 23, 2011 effective date. Guidance issued in November 2011 pushed off the timeline for compliance.
The forms released today are based on the Nutrition Facts food-labeling requirement for packaged foods and were created with public input through a process led by the National Association of Insurance Commissioners (NAIC). Health insurers and group health plans are required to provide the SBC and Uniform Glossary starting September 23, 2012.
The SBC is intended to help participants understand the health coverage they have and to allow them to compare their coverage to other health plans. Toward that end, the SBC must summarize important elements of coverage, including benefits, cost-sharing, coverage limitations and exceptions. The SBC will include a standardized health plan comparison tool with coverage examples. Each plan's SBC must include the costs the plan would cover for both a patient having a baby and a patient managing type 2 diabetes. Such uniform benefits examples will provide consumers a mechanism to compare plans based on standard situations. A group health plan or health insurance issuer must provide an SBC when an individual is looking for coverage, when the individual applies for coverage, at each new plan year and any time upon request.
Health insurers and group health plans will also be required to have a Uniform Glossary of health coverage terms available to help consumers understand potentially confusing language used in health plan documents.
The new guidance clarifies that for group health plans, the SBC can be either a stand-alone document or can be incorporated into a plan's summary plan description. It must be a stand-alone document in the individual insurance market. If certain safeguards are met, the SBC and Uniform Glossary can be provided electronically. The requirements apply to both insured and self-funded plans.
Sample documents are available at www.cciio.cms.gov or at www.dol.gov/ebsa/healthreform.
For more information, please contact Marla G. Roshkoff, General Counsel, at PR@BASusa.com