Health Care Reform Summary of Benefits and Coverage Guidance

Group health plans (including grandfathered plans) are required to provide a four-page, double-sided Summary of Benefits and Coverage (“SBC”) by March 23, 2012.  For fully-insured plans, insurance carriers are required to provide the summaries for each plan option available to employees by the March deadline.  Self-insured plans may either include the summaries with open enrollment now or wait until the proposed regulations are finalized.

The SBC will have a glossary of common health coverage terms, instructions, samples and a guide.  For example, it will have specific common questions enrollees may have, the answer, and explanations about why this matters.  Another section will outline common medical events, services which may be needed related to that event, costs for each service and any limitations/exceptions.  Another section will give details about three specific situations:  having a baby, treating breast cancer and managing diabetes.  (Other situations may be required as well.)  Final regulations for the summary should be available sometime after October 21.   

A sample SBC document may be found at www.healthcare.gov/news/factsheets/2011/08/labels08172011b.pdf.  However, final regulations may require significant changes to this example.

From Employee Benefits Briefing by Woodruff Sawyer & Company, August 2011 issue, p. 3.  Also from Business Insurance, August 22, 2011 issue, pp. 4 and 21.