Tag Archives: summary of benefits coverage

Extension of Due Date for Summary of Benefits Coverage under PPACA

On November 17, 2011, the Departments of Labor, Treasury and Health and Human Services issued a set of Frequently Asked Questions About Affordable Care Act Implementation (Part VII) and Mental Health Parity Implementation.  In FAQ 1, the Departments noted that they received many comments on the proposed regulations concerning the requirement to provide group health plan participants and beneficiaries with a summary of benefits coverage that accurately describes the benefits and coverage available under the plan and a uniform glossary of terms (“SBC”).  The FAQs provide that the Departments intend to issue, as soon as possible, final regulations that address these comments and other feedback on the proposed regulations and requirements.  The Departments stated that until final regulations are issued and applicable, plans and issuers are not required to comply with the SBC requirements.  Although the FAQs do not provide information regarding when the final regulations will be issued, they do state that “it is anticipated that the Departments’ final regulations, once issued, will include an applicability date that gives group health plans and health insurance issuers sufficient time to comply”.  Thus, it appears that there will not be a March 23, 2012 effective date for compliance with the SBC requirements.  However, the issuance of the final regulations and the applicability date will need to be monitored.  It would be advisable to continue preparations for compliance with the SBC requirements under current guidance (i.e., gathering and organizing necessary information) and then make any necessary modifications once the final regulations are issued during a final review prior to implementation.

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Get Ready for the Summary of Benefits Coverage under PPACA

On March 23, 2012, another requirement under the Patient Protection and Affordable Care Act (the “Act”)  will be effective-the requirement to provide group health plan participants and beneficiaries with a summary of benefits coverage that accurately describes the benefits and coverage available under the plan and a uniform glossary of terms (“SBC”).  These requirements were incorporated under the Internal Revenue Code and ERISA (in addition to existing summary plan description requirements).  Under currently proposed regulations, health insurance issuers will also be required to provide this type of information to group health plan sponsors at the time of application or request for information regarding coverage within seven days of the request (including an obligation to update such information should it change); this information must also be provided upon renewal (30 days in advance of a new policy year in a case of an automatic renewal).  

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