Summary of Benefits and Uniform Glossary Regulations

On Februray 9, 2012, final regulations were released regarding the Summary of Benefits and Coverage (SBC) and Uniform Glossary requirements for health insurance plans. The goal is to provide consumers with simple information on plan coverage and help consumers better understand the coverage they have in order to compare differences in benefits and coverages when they are shopping for a new plan.

Beginning on the first day of the first open enrollment period that begins on or after September 23, 2012, plans must provide the SBC to participants and beneficiaries who enroll or re-enroll for coverage during the open enrollment period. Additionally, an SBC must be provided to all participants and beneficiaries who do not enroll during an open enrollment period, including newly eligible individuals and special enrollees, on the first day of the first plan year that begins on or after September 23, 2012.

An SBC must be provided as either a stand alone document or in combination with other summary materials, but it must be prominently displayed at the beginning of the document. A template of the SBC is available for use here from the U.S. Department of Labor, in addition to the Uniform Glossary. Groups are also required to provide participants and beneficiaries who reside in a county where 10% or more of the population is literate in the same non-English language, a copy of the SBC and Uniform Glossary in the non-English language. The Department of Health and Human Services has agreed to provide written translations of the SBC template to comply with this requirement and post on their website.

Be sure to visit the U.S. Department of Labor Health Reform website for full details and instructions regarding the latest SBC regulations, and as always, feel free to contact us at MedCon Benefit Systems with any questions.