The U.S. Department of Labor (DOL) released a new template for the Summary
of Benefits and Coverage (SBC) last year. As background, the
Affordable Care Act requires health plans and health insurers to
annually distribute SBCs to participants and enrollees. SBCs
provide a general overview of covered benefits and cost-sharing,
along with examples, in a format prescribed by the DOL.
Health plans and health insurers will be required to use the new
version beginning on the first day of the first open enrollment
period that begins on or after April 1, with respect to coverage
for plan years beginning on or after that date. For calendar-year
plans, the new version must be used for the 2017 open enrollment
period concerning January 1, 2018, coverage. The SBC format remains
largely unchanged. The new SBC template contains some minor
changes, including these notable modifications:
- A third coverage example regarding a foot fracture treated in the emergency room
- Revised language regarding minimum essential coverage, continuation coverage, and minimum value
- A description of the embedded deductible for family coverage
- Deleted content (e.g., questions and answers about the coverage examples), reducing the SBC from eight pages to five pages
- An updated glossary
For more information, visit the DOL webpage for SBCs.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.