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March 15, 2016
On February 22, 2016, the Departments of Labor, Treasury, and Health and Human Services (“the Departments”) released proposed updates to the Uniform Summary of Benefits and Coverage (SBC) template, instructions, and Uniform Glossary (“glossary”). The proposed documents build largely on the revisions first proposed in December 2014. However, they incorporate additional stakeholder feedback—primarily from the NAIC—and the Departments are requesting public comments through the end of March before the documents are finalized.
The Affordable Care Act (ACA) requires that an SBC and an accompanying uniform glossary be provided for all group health plans “to help plans and individuals better understand their health coverage.” Plans and issuers must provide an SBC and accompanying uniform glossary to applicants and enrollees, including beneficiaries, at the time of application, enrollment, or re-enrollment. The SBC requirement applies to group health plans (both self-insured and fully-insured, including grandfathered group health plans) and insurers. Certain excepted benefits and retiree-only plans are exempt.
In February 2012, the Departments released rules for the first time, along with an accompanying SBC template, instructions, and uniform glossary. In light of these rules, the requirement to provide an SBC generally took effect for renewals beginning on or after September 23, 2012.
In December 2014, the Departments released proposed rules revising the existing SBC requirements. Although those rules were finalized last summer, the Departments indicated in an earlier FAQ that the revised SBC template, instructions and glossary would not be finalized until 2016, thereby allowing for additional stakeholder feedback.
The comment period for these proposed revisions extends through March 28, 2016. These documents are expected to be effective for coverage beginning in 2017.
Plans and issuers must use the full SBC template and must use “best efforts” to describe their plan’s terms in a manner consistent with the template and instructions.
Changes to Revised SBC Template, Instructions & Glossary
The proposed revised template contains several modifications to the existing template:
The proposed group instructions contain significant revisions to the existing version. They include:
The glossary contains revisions to existing definitions and a number of additional definitions, including an added reference to “in-network” and “out-of-network” providers (instead of solely using “preferred” and “non-preferred”); definitions for MEC and MV; and cost-sharing definitions.
The instructions specify that any defined terms in the glossary must also be underlined in the SBC, and permit plans and issuers providing electronic SBCs to hyperlink defined terms directly to the glossary, and/or employ hover text applications that would display the term’s definition when a reader places their cursor over the term.
It will be interesting to see how the public and other stakeholders view the revisions. Although several NAIC recommendations appear to have been adopted, the documents as a whole remain closely aligned with the versions proposed in 2014. This is partially due to statutory space limitations, but may also stem from the fact that determining how best to present this level of complex information continues to be objectively less clear.
The proposed template, instructions, and uniform glossary can be found here.
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