Healthcare Reform Summary of Benefits Updated Forms

By: Stephanie Edwards, Capstone Brokerage Benefits Account Manager, April 27, 2016

The federal agencies have finalized the new versions of the summary of benefits coverage (SBC) template. For all businesses, this template will be used starting for plan years beginning on or after April 1, 2017. Under the Affordable Care Act, group health plans and health insurance providers are now going to be required to provide a SBC to all plan participants during open enrollment for company benefit coverage. As per the Affordable Care Act, all businesses will now be required to provide additional information to their employees.

The requirements to use the new SBC template and all associated documents will implement as follows:

• Businesses that utilize health plans that have an open enrollment period will now be required to use the new documents on the first day of the first open enrollment that starts on or after April 1, 2017.

• Businesses that do not use annual open enrollment will be required to use the new editions on the first day of the first plan year which begins on or after April 1, 2017.

As discussed last month, the deadline was extended for providing a summary of benefits to employees. The reason behind the changes and new requirements for the summary of benefits is to help employees have a better understanding of the overage they are being offered. The language used in the new templates will include more information about cost, deductibles, and out of pocket limits. The new language that will be required to use will improve the readability of this information and will improve an individual’s understanding of their health coverage.

What changes were made?

One of the biggest changes of the final SBC is now there is a way to use an electronic SBC that is able to be hyperlinked to the uniform glossary. Meaning, now each insurance term can be linked to a definition from the electronic document. This will provide an easier understanding to individuals, as the new language used is now more reader friendly. The hope is this will decrease any misunderstandings whereas before it was very confusing and difficult for the average person to understand the language used in a SBC.

The final SBC template is pretty much unchanged from the proposed version. The only real difference is coverage examples are now provided for both plans that use coinsurance and copayments for the for the services listed. The uniform glossary of terms remained the same as well however the definitions as mentioned above were improved to enhance readability for indiduvals.

The U.S. Department of Labor has created a SBC and Uniform Glossary to help make accessing the new templates and related documents much easier for businesses.

As always, your insurance advisor or broker can help with any additional information you may need. The importance of compliance can not be stressed enough. For more information on this topic, please feel free to contact our office anytime. We also provide ACA compliance assessments free of charge for your small or large business.