New Rules for Summary of Benefits and Coverage

Issued March 8, 2012

On February 9, 2012, the Department of Health and Human Services released the final rules mandating that consumers have access to two key documents provided by health insurance carriers and self-funded group health plans – a Summary of Benefits and Coverage (SBC) and a uniform glossary of commonly used terms. The goal is to provide coverage information in a way that allows consumers to easily compare health plans to help choose the coverage that best fits their needs.

The SBC will be a summary of the plan or coverage, with a focus on key features such as:

  • covered benefits;
  • cost-sharing requirements;
  • limits on coverage; and
  • excluded benefits.

The rules state that consumers should receive the SBC:

  • when shopping for coverage;
  • when coverage is renewed;
  • whenever material changes are made to the plan during the plan year; and
  • on demand.

These rules go into effect for plan years beginning on or after September 23, 2012 to give insurers and plans more time for implementation. We are reviewing the released rules document to determine how it may best support our clients in meeting this requirement.