Recently issued final regulations and related guidance clarify the requirement under the Patient Protection and Affordable Care Act that group health plans and health insurance issuers provide a summary of benefits and coverage and a uniform glossary.  The guidance includes final regulations and sample summaries and instructions.

The Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (PPACA), generally requires group health plans and health insurance issuers offering group or individual health insurance coverage to provide a summary of benefits and coverage (SBC).  On February 14, 2012, the U.S. Departments of Treasury, Labor, and Health and Human Services released final regulations governing the SBC requirement, which are generally applicable beginning September 23, 2012.  The final regulations and related guidance clarify and make multiple changes to the proposed regulations issued in August 2011, including the elimination of the requirement that the SBC contain premium information and clarifications to the rules governing the electronic disclosure of SBCs.   

Requirement to Provide SBC

The final regulations require plan administrators of group health plans (or health insurance issuers in the case of fully insured plans) to provide an SBC to participants and beneficiaries for each benefit package under the plan.   In addition, the health insurance issuer is required to provide an SBC to the group health plan sponsor.  The preamble to the final regulations clarifies that an SBC is not required to be provided for plans, policies or benefit packages that are excepted benefits, such as stand-alone dental or vision plans, and certain health flexible spending arrangements.  The preamble also clarifies that health reimbursement arrangements (HRAs) generally are not excepted benefits and are usually subject to the SBC requirements, while health savings accounts (HSAs) generally are not group health plans and are not usually subject to the SBC requirements.

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