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Agencies Issue Regulations on Summary of Benefits and Coverage Requirements

The Departments of the Treasury, Labor and Health and Human Services (collectively, the "Departments") recently published the final regulation (the "Regulation") with regard to the Summary of Benefits and Coverage ("SBC") requirements under the Patient Protection and Affordable Care Act ("PPACA").  The Regulation implements certain disclosure requirements in order to help individuals and health plans better understand their medical coverage as well as other coverage options.  Many liken the SBC to the summary plan description for retirement plans.

The Regulation, among other things, establishes standards for the definitions of terms used in health insurance coverage to ensure that information is presented to consumers in a clear and uniform format.  Additionally, the Regulation also provides standards with regard to the issuance of an SBC, and certain required content elements.  In addition to establishing the standards for the SBC, the Regulation also establishes the timeframe in which the SBC must be implemented.

The Regulation applies with regard to disclosures to plan participants and beneficiaries who enroll (or re-enroll) in group health coverage through an open enrollment period that begins on or after September 23, 2012.  In regard to participants and beneficiaries who enroll in group health plan coverage other than through an open enrollment period, the Regulation applies beginning on the first day of the first plan year that begins on or after September 23, 2012 (January 1, 2013 for calendar year plans).  The Regulation applies to health insurance issuers beginning on September 23, 2012 for disclosures to plans, and for disclosures to individuals and dependents in the individual market.

In addition to the Regulation, the Departments also issued other various documents including a model SBC template, instructions for completing the SBC, and a template for the uniform glossary of coverage and medical terms.  These documents are available at the Departments' web site (We have identified that the following link is no longer active, and it has been removed).  If you have any questions regarding the Regulation or need assistance in drafting an SBC, please contact a Foster Swift attorney using the form below.

Categories: Employee Benefits, Employment, Insurance, Regulatory, Retirement


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