ACA Regulations Regarding Summary of Benefits & Coverage Requirements Finalized
The Departments of Health and Human Services, Labor, and Treasury (the “Departments”) recently finalized changes to regulations governing the summary of benefits and coverage (“SBC”), which were published in the Federal Register on June 16, 2015. The final regulations generally track the proposed regulations in codifying certain pieces of interim and informal guidance, including guidance regarding a plan sponsor’s responsibly to ensure compliance with the SBC rules if the plan sponsor chooses to contract with a third party with respect to SBC compliance. The final regulations also contain provisions that are intended to reduce unnecessary duplication when providing SBCs and clarify that plan sponsors and issuers of insured coverage (and not self-insured coverage) must include an Internet web address where copies of the actual individual coverage policy or group certificate of coverage can be reviewed and obtained. For employer-sponsored plans, the final regulations are generally applicable for SBCs issued in conjunction with open enrollments beginning on or after September 1, 2015, and for all other SBC distribution events relating to plan years beginning on or after September 1, 2015.
The proposed regulations contained proposed changes to the SBC template, uniform glossary, and other supporting documentation. On March 30, 2015, the Departments stated in a Frequently Asked Question that the Departments wanted to offer the public more time to review and provide input before finalizing those documents. The Departments intend to finalize the new SBC template and associated documents by January 2016. The new template will apply for coverage that begins on or after January 1, 2017, including any coverage with an open enrollment in fall of 2016.
For additional Affordable Care Act resources, visit AGC’s members’-only webpage at www.agc.org/ACA.
Editor's note: This article was written by guest authors Jennifer A. Craft and Christina M. Cerasale. Both Christina and Jennifer are members of Seyfarth Shaw’s Employee Benefits and Executive Compensation Team. This publication is intended for general information purposes only and does not and is not intended to constitute legal advice. The reader must consult with legal counsel to determine how laws or decisions discussed herein apply to the reader's specific circumstances.
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