The feds just issued new proposed regulations for implementing the benefit summary requirements of the healthcare reform law. Here’s what you need to prepare for.
The proposed regulations by the departments of Health and Human Services, Labor, and the Treasury are designed to provide health plan participants with a clearer picture of their healthcare coverage and options than traditional SPDs (summary plan descriptions).
Some highlights of the new regs:
- The newly-required coverage description, known as a “Summary of Benefits and Coverage” (SBC), can be no more than four double-sided pages.
- The SBC must generally be delivered at least 30 days prior to reissuance or renewal of health coverage and should be distributed with written open enrollment materials.
- Health plans and issuers must also provide notice at least 60 days before any significant mid-year modification is made in the plan or coverage. This does not apply to changes taking effect at the time of renewal — those will need to be reflected in the SBC issued at least 30 days prior to renewal.
- Plans and insurers will have to provide an SBC for each benefit plan for which a participant is eligible. But at renewal, a participant only needs to receive the SBC for the plan in which he/she is enrolled, unless another is requested for comparison purposes.
- Plans and insurers will have to provide an SBC within seven days following a request for one.
- Included with the SBC must be a uniform glossary of terms commonly used in health insurance coverage, such as “deductible” and “co-pay.”
- Each SBC will have to include a policy comparison tool known as “Coverage Examples,” which is being compared to the Nutrition Facts label required on food packages. The intent of the labels is to aid participants in plan comparisons by providing an idea of how much plans will cover and how much participants will be expected to pay out of pocket for three common types of treatment — maternity care, diabetes treatment and breast cancer treatment.
- The healthcare reform law requires plans and insurers to distribute these summaries no later than March 23, 2012.
Fact Sheet, template comments
Additional resources:
- For the feds’ Fact Sheet on the proposed regulations, click here.
- To view the proposed template for the Summary of Benefits and Coverage, click here.
- To submit a comment on the regulations, click here.
