Changes to SBC Template Coming

On April 6, 2016, the Centers for Medicare & Medicaid Services (CMS) published the final template for the Summary of Benefits and Coverage (SBC) and Uniform Glossary.  Health plans must use the new SBC template and Uniform Glossary on the first day of the first open enrollment period that begins on or after April 1, 2017, with respect to coverage for plan years beginning on or after that date.

The SBC is a summary document that group health plans are required to provide to participants and beneficiaries when they initially enroll or re-enroll in the plan, upon request, and whenever there is a material modification in any of the terms of the plan that is not reflected in the most recently provided SBC.  The purpose of the SBC is to provide participants and beneficiaries with consistent, concise, and comparable information regarding a health plan’s benefits and coverage in order to assist them in better understanding their available coverage options and associated costs.

The changes include, but are not limited to, the following:

• Question identifying any services covered before the deductible is met
• Language to identify whether the plan has embedded or non-embedded deductibles or out-of-pocket maximums
• Language to identify whether the plan uses a tiered network to alert participants that costs for in-network services may vary depending on the tier of the physician or facility
• List of certain core limitations, including when cost-sharing for in-network services does not count toward the out-of-pocket limit as well as prior authorization requirements, visit limits, or exclusion of a particular service category or substantial part of a service category
• Coverage example for a simple fracture
• Statement indicating whether the plan meets Minimum Essential Coverage and Minimum Value.

According to the CMS, the revised regulations are intended to improve the presentation of information to consumers when they choose or renew coverage and to ease plan providers’ burden of producing and distributing that information.

If you have questions about the changes to the SBC templates, visit the DOL’s Website here or call ASR Health Benefits at (616) 957-1751 or (800) 968-2449.