Agencies Release ACA Final Rule, Guidance and Templates for Summary of Benefits and Coverage (SBC) and Uniform Glossary of Terms

The Departments of Labor, Treasury and Health and Human Services have released final regulations under the Affordable Care Act (ACA) that require health insurers and group health plans to provide concise and comprehensible information about health plan benefits and coverage to those with private health coverage. The goal is to make it easier for individuals and employers to directly compare one plan to another.
 
Under the rule, health insurers must provide consumers with clear, consistent and comparable summary information about their health plan benefits and coverage. The new explanations will be available beginning, or soon after, September 23, 2012.

Specifically, these rules will ensure consumers have access to two key documents that will help them understand and evaluate their health insurance choices:
  • A short, easy-to-understand Summary of Benefits and Coverage (SBC); and
  • A uniform glossary of terms commonly used in health insurance coverage.
All health plans and insurers will provide an SBC to shoppers and enrollees at important points in the enrollment process, such as upon application and at renewal. A key feature of the SBC is a new, standardized plan comparison tool called “coverage examples,” similar to the Nutrition Facts label required for packaged foods. The coverage examples will illustrate sample medical situations and describe how much coverage the plan would provide in an event such as having a baby (normal delivery) or managing Type II diabetes (routine maintenance, well-controlled). These examples will help consumers understand and compare what they would have to pay under each plan they are considering.
 
The rules finalize the proposed rules issued in August 2011. Input was received from such stakeholders as the National Association of Insurance Commissioners (NAIC) and a working group composed of health insurance-related consumer advocacy organizations, health insurers, health care professionals, patient advocates including those representing people with limited English proficiency, and others.

The rule's effective date is April 16, 2012. The applicability date is generally September 23, 2012 (or the first day of the first plan year after this date, or the first day of the first open enrollment period after this date).