New SBCs for 2015 – for use on/after September 1, 2015

New SBCs for 2015 – for use on/after September 1, 2015

DEPTS

The Departments (Departments of Health and Human Services, Labor, and the Treasury) released proposed changes to the regulations regarding SBCs (Summary of Benefits and Coverage) and the uniform glossary that goes with it. These proposed regulations amend the final regulations that were published on 02/14/2012 (the 2012 final regulations) and includes revisions to the templates, instruction guides, uniform glossary, and other supporting materials for compliance with the regulations.

Today’s proposed rules generally address the requirements for SBCs and uniform glossaries that, if finalized, would be available to consumers with respect to coverage that begins on or after September 1, 2015.

SBC Coverage Examples

Consumer testing has shown that the SBCs coverage examples are a useful feature for many consumers. The Departments are authorized to develop up to six coverage examples for the SBC and have taken a phased approach to implementing the coverage examples. The proposed regulations would retain the two current coverage examples of “having a baby (normal delivery)” and “managing diabetes type 2 (for a well-controlled condition)” and add a third example regarding a simple foot fracture with emergency room visit. Updates to the underlying pricing data are also being proposed so that the examples would more accurately reflect the allowed charges experienced by consumers in the private insurance market. The Departments also propose to permit plans and issuers to continue using the HHS-provided coverage examples calculator as an alternative means of completing the coverage examples.

Links: 

Documents Available for Public Comment

In addition to the Federal Register Notice that includes these proposed rules, the following documents, available at http://cciio.cms.gov and www.dol.gov/ebsa/healthreform are available for review, and the Departments solicit comment on them:

  1. SBC template.
  2. Sample completed SBC. This document was completed using information for sample group health coverage and provides a general illustration of a completed SBC.
  3. Instructions. For assistance in completing the SBC template, separate instructions are available for group health coverage and for individual health insurance coverage.
  4. Why This Matters language. The SBC instructions include language that must be used when completing the “Why This Matters” column on the first page of the SBC template.
  5. Coverage examples. The Federal Register Notice, together with information provided in Microsoft Excel format by HHS at http://cciio.cms.gov(and accessible via hyperlink from www.dol.gov/ebsa/healthreform), provides all the information necessary to perform the coverage example calculations.

 Reference links – SBCs

Templates, Instructions, and Related Materials – Currently Applicable (SBCs Before 9/1/2015)

Templates, Instructions, and Related Materials – Proposed (SBCs On or After 9/15/2015)

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