Health Care Reform – Proposed Rules for Summary of Benefits and Coverage

Under the Patient Protection and Affordable Care Act, insurers and employers alike will need to provide a Summary of Benefits and Coverage (SBC) – a standardized plain-English description of benefits, coverage and costs – for each health care plan they offer. From lawyers and law firms on JD Supra, here’s what you need to know about the recently proposed SBC regulations. We’ll continue to update this list as additional updates come in:

New Summary of Benefits and Coverage Required for Health Plans in 2012 (Morgan Lewis):

“The Patient Protection and Affordable Care Act (PPACA) requires that insurers and group health plans (whether or not grandfathered) provide an SBC for each coverage option offered by the insurer or plan. … The Departments have proposed a template for the SBC, as well as a separate uniform glossary of terms commonly used to describe health coverage, such as ‘co-pay’ and ‘deductible.’ The new SBC requirements are proposed to apply as of March 23, 2012, although the Departments signaled in the proposed regulations that ‘practical considerations might affect the timing of implementation.’” Read more»

Guidance on New Disclosure Requirement for Group Health Plans and Insurers: Introducing the “SBC” (Davis Wright Tremaine LLP):

“The SBC’s purpose is to help consumers better understand their options and thereby make better-informed decisions about their health care coverage. Under the proposed regulations, insurers and group health plans would provide clear and consistent information to consumers in a short, easy-to-read format, using uniform terms. Because every group health plan would be outlined in an SBC, the use of SBCs is also expected to result in greater transparency in pricing and benefits information and help consumers, including plan sponsors, more accurately compare coverages.” Read more»

Details Released Regarding New “Summary of Benefits and Coverage” For Group Health Plans (Katten Muchin Rosenman LLP):

“The regulations mandate the SBC to use specific terms and examples. The required “Coverage Examples” are described as being similar to the ‘nutrition facts’ label required for packaged foods. The Coverage Examples would illustrate what proportion of care expenses the plan would cover for (1) having a baby, (2) treating breast cancer, and (3) managing diabetes.” Read more»


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