New SBC Template and Instructions

Posted by BAS - 28 April, 2016

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Under the Affordable Care Act, insurers and group health plans are required to provide a summary of benefits and coverage (SBC), in easy to understand language, to plan participants, beneficiaries, and other individuals who ask about plan coverage. A plan (or its administrator) that willfully fails to provide an SBC may be fined up to $1,000 for each failure. 

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. The SBC must summarize important elements of coverage, including benefits, cost-sharing, coverage limitations and exceptions. Employers and insurers have been distributing SBCs since September 2012.

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) issued a proposed revised SBC template, proposed individual and group instructions and a proposed uniform glossary.

The new template is shorter than the previously provided document, and requires the inclusion of new information, such as addressing if services are covered before the deductible is met.  The template must be used after 4/1/2017.  The new documents are available here.


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