FAQs Regarding Summary of Benefits and Coverage Released; No Penalties for Plans and Issuers in Good Faith Compliance During the First Year of Applicability


On March 19, 2012, the U.S. Department of Labor posted the eighth in a series of FAQs on open questions under the Patient Protection and Affordable Care Act (ACA). The FAQs, which were prepared jointly by the Departments of Labor, Health and Human Services, and Treasury (the Departments), provide additional guidance on the implementation of the requirement that insurers and group health plans provide a summary of benefits and coverage (SBC). The FAQs are available here.

As detailed in our prior alert, on February 9, 2012, the Departments issued final regulations under section 2715 of the Public Health Service Act, which requires insurers and group health plans (other than those that provide excepted benefits) to provide an SBC to consumers, participants and beneficiaries.

Notably, the FAQs provide that, during the first year of applicability, the Departments will not impose penalties on plans and insurers that are working diligently and in good faith to provide the required SBC content in a manner that is consistent with the final regulations. The FAQs also state that the Departments do not anticipate making any significant changes to the SBC template for 2014, although the Departments noted certain “discrete changes” that will be necessary after the first year of applicability, as well as the possibility of additional refinements that may be made in response to other requests from plans and insurers.

Please see full alert below for more information.

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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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