August 2012 Health Care Reform

August 2012 Health Care Reform

by Posted on: August 8, 2012Categories: HR & Compliance   

Summary of Benefits & Coverage

We have previously covered Summary of Benefits and Coverage and are revisiting it because all groups that renew after September 23, 2012 must be in compliance with the new SBC requirements.

 The Patient Protection and Affordable Care Act (PPACA) requires health plans and health insurance issuers to provide a summary of benefits and coverage (SBC) to applicants and enrollees. Both non-grandfathered and grandfathered plans will need to provide the SBC.

The SBC is a concise document providing simple and consistent information about health plan benefits and coverage. It must be provided free of charge. Its purpose is to help health plan consumers better understand the coverage they have and to help them make easy comparisons of different options when shopping for new coverage.

On Aug. 22, 2011, the Departments of Health and Human Services (HHS), Labor and Treasury (Departments) issued proposed regulations for the SBC. On Feb. 9, 2012, the Departments announced the release of final SBC regulations.

The final regulations include guidance on:

  • The compliance deadline for plans and issuers to begin providing the SBC;
  • The requirements for providing the SBC, including who must provide it and when it must be delivered; and
  • The requirements for preparing the SBC, including its content, appearance and language.   



Click the link below for more information on the SBC, including the final template (with instructions, sample language and a guide for coverage examples calculations) and the uniform glossary:

 Click here to see the final SBC Regulations  

Click here to visit the Department of Labor’s website  (Part XIII and IX). 

 Click here to download a complete guide from aetna


connect with us