Agencies Propose Streamlined Health Plan SBC and Glossary

Comments sought on changes to summary of benefits and coverage (SBC) and uniform glossary templates

By Stephen Miller, CEBS Dec 30, 2014
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Proposed changes to the regulations regarding the summary of benefits and coverage (SBC) and uniform glossary documents that group health plans must provide annually at open enrollment were published in the Federal Register on Dec. 30, 2014, by the departments of Health and Human Services, Labor, and the Treasury.

SBCs must be provided for each “benefit package” for which an employee is eligible. Upon renewal, an SBC need only be provided for the specific benefit package in which a participant is enrolled. The SBC must also be provided to participants no later than seven days following a request.

The proposed rule would amend the final rule published on Feb. 14, 2012, and includes revisions to the current SBC template, instruction guide, uniform glossary and other supporting materials for compliance with the proposed regulations. Samples of current and proposed templates were posted on the Department of Labor’s website. If finalized, the revisions would take effect for coverage beginning on or after Sept. 1, 2015.

Current Templates

Proposed Templates

(effectiveon or after 9/15/2015)

Summary of benefits and coverage

Revised SBC

Instruction guide

Revised instruction guide

Uniform glossary

Revised uniform glossary

Source: U.S. Department of Labor.



The proposed changes are “designed to improve access to important plan information so consumers can make informed choices when shopping for and renewing coverage, as well as to provide clarifications that will make it easier for health insurance issuers and group health plans to comply with providing this information,” according to a fact sheet issued by the federal Centers for Medicare and Medicaid Services (CMS).

Formatting and Content Changes

The Affordable Care Act (ACA) limits the length of the SBC to four pages. The 2012 final rule interpreted this requirement as a limit of four double-sided pages for summarizing plan coverage and costs (excluding explanatory information about the SBC itself, which is also included in the template).

Under the proposed rule, the SBC for a standard group health plan would be shortened to two-and-a-half double-sided pages for summarizing plan coverage and costs. Information not required by the ACA and identified as less useful for consumers choosing coverage would be removed from the template.

The proposed rule would also make a number of changes to the content of the SBC and uniform glossary to reflect the ACA’s private insurance market reforms. For example, references to annual limits for essential health benefits and pre-existing condition exclusions would be removed. In addition, the disclosures relating to continuation of coverage, minimum essential coverage, and minimum value would be revised to provide more useful information to consumers.

For the uniform glossary, the rule proposes to revise some of the existing definitions and to add new definitions reflecting important insurance or medical concepts (such as “claim,” “screening,” “referral” and “specialty drug”), as well as key terms that are relevant in the context of the ACA (such as “individual responsibility requirement,” “minimum value” and “cost-sharing reductions”).

Reducing Unnecessary Duplication

The proposed rule would help prevent unnecessary duplication by requiring only a single SBC per group health plan when the plan sponsor:

  • Uses a binding contractual arrangement in which a third party assumes responsibility to provide the SBC.
  • Uses two or more insurance products provided by separate issuers to insure benefits with respect to a single group health plan.

In addition, the proposal clarifies that if a plan sponsor is negotiating group coverage terms after an application has been filed and information required to be in the SBC changes, the plan or issuer would not be required to distribute an updated SBC to employees (unless one is requested) until the first day of coverage.

The federal agencies are accepting comments on the proposed rule through March 2, 2015.

Stephen Miller, CEBS, is an online editor/manager for SHRM. Follow him on Twitter @SHRMsmiller.

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