The Affordable Care Act (ACA) requires plan sponsors and health insurance issuers to provide a Summary of Benefits and Coverage (SBC) to all participants at the beginning of each new plan year, when enrolling in coverage for the first time or within seven business days if a copy is requested. The standardized SBC provides a brief summary of what the plan covers and the cost-sharing obligations of the participant. Issuers and plan sponsors must also provide a uniform glossary of commonly used health insurance terms. The goal of these requirements is to help consumers better understand the features of their health plans so that they can compare options and make informed decisions on which plan best meets their needs.
The Departments of Health and Human Services, Labor and the Treasury recently announced changes to the SBC that are designed to help participants better understand their plans. The new templates include additional information about cost-sharing, including more information on individual and overall out-of-pocket limits.
The revised SBC template must be used by issuers and plan sponsors starting on the first day of the first open enrollment period that begins on or after April 1, 2017. If a plan or issuer does not use an annual open enrollment period, then the revised SBC template must be used for plan years beginning on or after April 1, 2017.
More information about the SBC, including the template and instructions, is available at the Department of Labor’s website.