On Feb. 9, 2012, the Departments of Health and Human Services, Labor and Treasury (Departments) released final guidance on the requirement for health plans and health insurance issuers to provide a summary of benefits and coverage to applicants and enrollees.

The health care reform law created the summary of benefits and coverage, or SBC, to provide consumers with simple and straightforward information on plan coverage in a uniform format. According to the Departments, the SBC will help consumers better understand the coverage they have and compare differences in benefits and coverage when they are shopping for a new plan.

FINAL SBC GUIDANCE

To implement this disclosure requirement, the Departments released final regulations outlining standards for preparing and providing the SBC. The final regulations modify the proposed SBC guidance that we reported on in August of 2011 (Unison Health Care Reform News August 25, 2011).    

In addition to the final regulations, the Departments also provided a final template for the SBC (along with instructions, samples and a guide for the coverage example calculations to be included in the SBC) and the uniform glossary explaining terms commonly used in health coverage.

The final regulations, template and uniform glossary are available through the Department of Health and Human Services at: http://cciio.cms.gov/programs/consumer/summaryandglossary/index.html.

DEADLINES

Originally, the health care reform law specified a March 23, 2012 deadline for plans and issuers to start providing the SBC. Given the lack of final guidance, the Departments delayed this compliance deadline.

Now that final guidance has been released, the Departments specified the following deadlines:

·  Beginning on the first day of the first open enrollment period that begins on or after Sept. 23, 2012, plans must provide the SBC to participants and beneficiaries who enroll or re-enroll for coverage during the open enrollment period.

·  Beginning on the first day of the first plan year that begins on or after Sept. 23, 2012, plans must provide the SBC to participants and beneficiaries who enroll for coverage other than through an open enrollment period, such as newly eligible individuals and special enrollees. 

·  Issuers must begin providing the SBC to plans on Sept. 23, 2012.

Thus, calendar year plans with an annual open enrollment period that takes place before the start of the plan year will generally need to start providing the SBC on the first day of the open enrollment period for the 2013 plan year.  The penalty for “willful” non-compliance will be up to $1000 per enrollee for each failure to comply.   

More Information

A more detailed summary of the SBC final guidance can be found here:  Details of Summary of Benefits and Coverage

We are waiting to hear from the carriers about how they will be handling the new regulations as they pertain to Minnesota fully insured and self funded health plans. As additional information becomes available from the government and from the carriers, Unison will continue to keep you up to date. As always, Unison will be working with each of the carriers and our clients to ensure that employees receive the correct information as needed and that all compliance regulations are met.

If you have any immediate questions concerning your company's health plan or any health care reform provisions, please contact your Unison Employee Benefits Consultant.