More Guidance Issued on Summaries of Benefits and Coverage


The U.S. Department of Labor has issued a set of frequently asked questions, together with a new template, for the Summary of Benefits and Coverage (SBC) that applies to group health plans and individual health insurance. The new rules and form modify the guidance that was in effect for the first SBCs that employers needed to provide to plan participants and will apply for coverage offered in 2014.

The new template includes two new entries that address whether the plan provides minimum essential coverage and meets the minimum value standard. Employers whose SBC preparation makes it too difficult to add new questions to the 2014 SBC at this time may address the issues in a cover letter.

The FAQs provide specific instruction regarding the entry on overall annual limits. Because annual limits will no longer be permitted for coverage beginning on January 1, 2014, the question on whether a plan contains such limits must be answered “no.” Alternatively, this entry may be deleted from the SBC entirely.

Otherwise, the guidance makes few changes. Most significantly, no new example is required to be included, and the FAQs extend various policies regarding relief from enforcement related to the SBCs.

As the federal health care reform effort gained steam, Ballard Spahr attorneys established the Health Care Reform Initiative to monitor and analyze legislative developments. With federal health care reform now a reality, our attorneys are assisting health care entities and employers in understanding the relevant changes and planning for the future. They also have launched the Health Care Reform Dashboard, an online resource center for news and analysis on developments under the Affordable Care Act.

If you have questions about the latest SBC guidance, contact Edward I. Leeds at 215.864.8419 or, or Robert S. Kaplan at 215.864.8417 or


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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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