Agencies Issue Final Rule Regarding Summary of Benefits and Coverage


The Departments of Health and Human Services, Labor, and the Treasury have issued final regulations under the Patient Protection and Affordable Care Act (the “Affordable Care Act”) to implement the requirement that group health plans and health insurance issuers provide consumers with a summary of benefits and coverage (SBC).1 This final rule makes some notable changes to the proposed regulations which are intended to help consumers better understand their health care coverage and choices while reducing the burden on health plans and issuers.


The Affordable Care Act requires group health plans and health insurance issuers offering group or individual health insurance coverage to provide enrollees a summary of benefits and coverage explanation that “accurately describes a plan’s benefits and coverage.” The SBC requirement applies to both grandfathered and non-grandfathered health plans. The final rule includes details on the content and format of the SBC as well as details about the notice of modifications that must be sent to enrollees and policyholders informing them of any significant changes in coverage that will occur in the middle of a plan year. In conjunction with the final rule, the agencies have issued a template for the SBC instructions, sample SBC language, examples of calculations, and a glossary of terms commonly used in health care coverage.

Please see full alert below for more information.

LOADING PDF: If there are any problems, click here to download the file.

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.

© Littler | Attorney Advertising

Written by:


Littler on:

JD Supra Readers' Choice 2016 Awards
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:

Sign up to create your digest using LinkedIn*

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.

Already signed up? Log in here

*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.