Summary of Benefits and Coverage  – Proposed Changes Recently Announced

Summary of Benefits and Coverage which have been evolving since 2014, are expected to be finalized this spring. The ACA requires health insurers and self-funded employers to provide a uniform Summary of Benefits and Coverage to people who apply for, and enroll in, health plans.

summary of benefits and coverageCurrent Summary of Benefits and Coverage requirements are based on final regulations issued in 2012, with several amendments added for a September 1, 2015 effective date.

However, the Department of Labor (DOL) just released proposed changes to the Summary of Benefits and Coverage template and related instructions on February 26, 2016 for final comments and review.

With a short comment period, only 30 days, the DOL has indicated these regulations will take effect on or after April 1, 2017.

While the general format of the Summary of Benefits and Coverage template remains the same, the following changes have been proposed:

  • Streamlined content, e.g. removal of Q&A about Coverage Examples, which reduced the template to 5 pages (Summary of Benefits and Coverage limit remains 8 pages/4 double-sided pages.)
  • An additional cost example for a foot fracture treated in an emergency room
  • Updated claims/pricing data for the coverage example calculator
  • New minimum essential coverage and minimum value language, as well as new continuation and appeals/grievance rights language
  • Revised language for some sections of the template
  • An updated Uniform Glossary

The above changes will not be required until these regulations are made final with an effective date.

Do you have a current copy of your plan’s Summary of Benefits and Coverage? If you are part of a Group Health Insurance, your employer should provide a copy every year at renewal time. If you want to know how to get your health plan’s Summary of Benefits and Coverage, contact us and we’ll be glad to help!