New SBC Template Goes Into Effect April 1

20 February 2017 Legal News: Employee Benefits & Executive Compensation Publication
Author(s): Nick J. Welle

Legal News: Employee Benefits & Executive Compensation

The U.S. Department of Labor (DOL) released a new template for the Summary of Benefits and Coverage (SBC) last year. As background, the Affordable Care Act requires health plans and health insurers to annually distribute SBCs to participants and enrollees. SBCs provide a general overview of covered benefits and cost-sharing, along with examples, in a format prescribed by the DOL.

Health plans and health insurers will be required to use the new version beginning on the first day of the first open enrollment period that begins on or after April 1, with respect to coverage for plan years beginning on or after that date. For calendar-year plans, the new version must be used for the 2017 open enrollment period concerning January 1, 2018, coverage. The SBC format remains largely unchanged. The new SBC template contains some minor changes, including these notable modifications:

  • A third coverage example regarding a foot fracture treated in the emergency room
  • Revised language regarding minimum essential coverage, continuation coverage, and minimum value
  • A description of the embedded deductible for family coverage
  • Deleted content (e.g., questions and answers about the coverage examples), reducing the SBC from eight pages to five pages
  • An updated glossary

For more information, visit the DOL webpage for SBCs.

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