Agencies Issue FAQs on SBC Requirements


The tri-agency task force has released new FAQs on the rules requiring group health plans and health insurers to issue Summaries of Benefits and Coverage (SBCs) under the Patient Protection and Affordable Care Act (PPACA). The FAQs are Part VIII in a series of informal PPACA guidance issued by the task force since March 2010. These FAQs address the effective date for the SBC rules; the ability to consolidate certain information on an SBC; certain other format, delivery and content requirements; and the agencies’ expected enforcement approach during the first year. In perhaps the most significant FAQ, the agencies also provide at least temporary relief from the rule in the final regulations that would have made plans and issuers responsible for the accuracy and timeliness of SBCs even if they had contracted with a provider to prepare and/or deliver the SBCs.


Section 2715 of the Public Health Service Act (PHSA), as added by PPACA, directs the agencies to work with a National Association of Insurance Commissioners (NAIC) working group to develop standards for compiling a four-page summary of benefits and coverage for enrollees in group and individual health plans. On August 22, 2011, the task force issued proposed SBC regulations and a draft template with an effective date of March 23, 2012, but requested comments on a number of open issues. In response to public comments, the task force issued FAQs on November 17, 2011, delaying the effective date of the rules until final regulations were released. The agencies released the final SBC regulations, the final SBC template and other related guidance on February 14, 2012, all of which were discussed in a previous Sutherland Legal Alert that can be found here. Although a number of questions remain unanswered by that guidance, most calendar year group health plans will be required to issue SBCs to participants as soon as the fall 2012 open enrollment season.

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