H&W: Proposed Summary of Benefits and Coverage

Proposed Summary of Benefits and Coverage: The U.S. Departments of Labor, Health and Human Services, and the Treasury proposed new rules under the Affordable Care Act on disclosure of the summary of benefits and coverage and the uniform glossary for group health plans and health insurance coverage in the group and individual markets.

Under the proposed rules, all health plans and issuers would provide a summary of benefits and coverage (SBC), along with a uniform glossary of terms, to enrollees upon request and before they enroll in a group health plan.  This summary of benefits and coverage would include a new, standardized health plan or policy comparison tool known as “coverage examples.” The coverage examples would illustrate what proportion of care expenses a health insurance policy or plan would cover for three common benefits scenarios — having a baby, treating breast cancer and managing diabetes. Additional scenarios may be added in the future.

The rule also requires that health plans and issuers must provide notice at least 60 days before any significant modification is made in the plan or coverage during the plan or policy year.

For more information, see the news release, fact sheet,  proposed rule, or the proposed template for the SBC.