Tag Archives: Summary of Benefits and Coverage

HEALTH REFORM: Paying Attention to the Fine Print: The Summary of Benefits and Coverage Final Rule and Its Impact on Consumers and the Health Insurance Market

On February 14, 2012, the U.S. Department of the Treasury, Department of Labor, and Department of Health and Human Services (collectively referred to as the “Departments”) published the Summary of Benefits and Coverage (“SBC”) Final Rule (the “Final Rule”)[1]¬†implementing Section 2715 of the Public Health Service Act (“PHSA”), as added by the Patient Protection and Affordable Care Act (“PPACA”). This section of PPACA required the Departments to develop standards for use by group health plans and health insurance issuers offering group or individual health coverage in providing SBCs. Accordingly, the Final Rule details how the Departments envision an SBC that “accurately describes the benefits and coverage under the applicable plan or coverage.”[2]¬†Additionally, the Final Rule sets forth a list of key definitions (“uniform glossary”) meant to help explain insurance terms.

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Summary of benefits for group health plans and regulations issued

 

Background

One requirement under the legislation collectively referred to as Health Care Reform mandates that group health plans and health insurance issuers offering group health plans provide a written Summary of Benefits and Coverage (SBC) for each group health plan option offered.

Recently, the Internal Revenue Service (IRS), the Department of Labor (DOL) and the Department of Health and Human Services (HHS) (the Agencies) jointly issued final regulations dealing with the technical requirements for these SBCs. 

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