The Departments of Labor, Treasury and Health and Human Services have released final regulations under the Patient Protection and Affordable Care Act (PPACA) that require health insurers and group health plans to provide concise and comprehensible information about health plan benefits and coverage to those with private health coverage. Under the rule, health insurers must provide consumers with clear, consistent and comparable summary information about their health plan benefits and coverage. The new explanations will be available beginning, or soon after, Sept. 23, 2012.
Specifically, these rules will ensure consumers have access to two key documents that will help them understand and evaluate their health insurance choices: a short, easy-to-understand Summary of Benefits and Coverage (SBC); and, a uniform glossary of terms commonly used in health insurance coverage.
All health plans and insurers will provide an SBC to shoppers and enrollees at important points in the enrollment process, such as upon application and at renewal. A key feature of the SBC is a new, standardized plan comparison tool called “coverage examples,” which will illustrate sample medical situations and describe how much coverage the plan would provide in an event such as having a baby (normal delivery) or managing Type II diabetes (routine maintenance, well-controlled).
The rule’s effective date is 60 days after publication in the Federal Register (scheduled for Feb. 14, 2012). The applicability date is generally Sept. 23, 2012 (or the first day of the first plan year after this date, or the first day of the first open enrollment period after this date).
- Final rule
- Guidance for Compliance
- Summary of Benefits and Coverage (SBC) Template | MS Word Format
- Sample Completed SBC | MS Word format
- Instructions for Completing the SBC – Group Health Plan Coverage
- Instructions for Completing the SBC – Individual Health Insurance Coverage
- Why This Matters Language for “Yes” Answers
- Why This Matters Language for “No” Answers
- HHS Information For Simulating Coverage Examples
- Uniform Glossary of Coverage and Medical Terms
