The U.S. Departments of Labor, Health and Human Services and Treasury jointly issued Frequently Asked Questions about the Summary of Benefits and Coverage (SBC) required under the Affordable Care Act (ACA). The ACA requires group health plans and health insurance issuers to provide an SBC document that accurately describes the benefits and coverage under the applicable plan or coverage.
Guidance issued in the fall of 2019 updated coverage examples calculator, the instructions for completion and the template document. The new FAQs offer guidance about the updates. Specifically, the FAQs address the implementation date for the new template and the required use of the calculator.
- Plans will be required to use the 2021 SBC, Instructions, Guide and Narratives beginning on the first day of the first open enrollment period for any plan years that begin on or after January 1, 2021.
- Plans are not required to use the updated calculator to generate out of pocket expected costs and may instead use their own calculator to generate out of pocket costs a participant will be expected to pay.
- Plans will have to identify coverage for COVID-19 related expenses.
To access the FAQs, click here.
