Smart Benefits: New SBC Template Delayed ‘Til 2016

Rob Calise, GoLocalProv Business/Health Expert

Smart Benefits: New SBC Template Delayed ‘Til 2016

While a notice of proposed rule-making issued in December stated that employers would have to use a new Summary of Benefits and Coverage (SBC) template and associated documents as of September 1, 2015, the Department of Health and Human Services, Treasury Department and Department of Labor recently published an FAQ that delays implementation. 

According to the FAQ, the Departments expect that the new template will be finalized by January 2016 and will apply to coverage that renews or begins on the first day of the first plan year (or, in the individual market, policy year) that begins on or after January 1, 2017.

The proposed revised SBC template is intended to better enable plan members to understand what their health insurance covers. To accomplish this goal, the new template is expected to change in several ways, including:

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  • The document will be shortened.
  • It will eliminate certain questions, such as language about annual limits.
  • The template will remove some explanations of terms that are in the Uniform Glossary.
  • Information about the plan's status as providing minimum essential and minimum value coverage would need to be included on the SBC itself and not separate.
  • It will add a coverage example that details the expenses a plan participant could expect to pay for emergency department care for a foot fracture.

In addition, the SBC instructions, example calculator and Uniform Glossary are being updated as well. 

Rob Calise is a founding partner of Cornerstone Group, where he helps clients control the costs of employee benefits by focusing on consumer driven strategies and on how to best utilize the tax savings tools the government provides. Rob serves as Chairman of the Board of United Benefit Advisors, and is a board member of the Blue Cross & Blue Shield of RI Broker Advisory Board, United HealthCare of New England Broker Advisory Board and Rhode Island Business Healthcare Advisors Council. He is also a member of the National Association of Health Underwriters (NAHU), American Health Insurance Association (AHIA) and the Employers Council on Flexible Compensation (ECFC), as well as various human resource associations. Rob is a graduate of Bryant University with a BS in Finance.

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