Agencies Issue Final Rule Regarding Summary of Benefits and Coverage

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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.

Background

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.

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