EBIA Weekly Newsletter

Agencies Delay Use of Revised SBC Template and Related Materials

   March 17, 2016

FAQs about Affordable Care Act Implementation (Part 30) (Mar. 11, 2016)

DOL website

HHS website

Visit the Health Care Reform Community on Checkpoint to join the discussion on this development (for Checkpoint subscribers to EBIA’s Health Care Reform manual).

The DOL, HHS, and IRS have jointly issued a single FAQ indicating the intended implementation date for using the revised template for the summary of benefits and coverage (SBC) and related materials (e.g., instructions and uniform glossary). Proposed revisions to the SBC template and related materials were published in February, along with a request for comments by March 28 (see our Checkpoint article).

According to the FAQ, the agencies expect to review the comments and finalize the new template and related materials “expeditiously” with the intent that plans and insurers will be required to use the revised template and related materials starting with 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. Thus, for calendar-year plans, the revised SBC template would not apply until the 2017 open enrollment period relating to coverage beginning on or after January 1, 2018. For plans and insurers that do not use an annual open enrollment period, the revised materials would be required beginning on the first day of the first plan year that begins on or after April 1, 2017.

EBIA Comment: The intended extension should provide plan administrators and insurers sufficient time to implement the changes, so long as the materials are in fact finalized expeditiously. Contemporaneous with the joint agency FAQ, HHS separately issued additional SBC-related FAQs directed at insurers, affecting coverage in the individual market and in the federal Exchange. For more information, see EBIA’s Health Care Reform manual at Section XVI (“Summary of Benefits and Coverage (SBC)”) and EBIA’s ERISA Compliance manual at Section XXIV.O (“Summary of Benefits and Coverage (SBC) Under Health Care Reform”). See also EBIA’s Self-Insured Health Plans manual at Section XXVIII.C (“Summary of Benefits and Coverage (SBC)”) and EBIA’s Group Health Plan Mandates manual at Section XXVIII.C (“SBC Disclosures About Group Health Plan Mandates”). You may also be interested in our upcoming webinar “It’s Almost Open Enrollment: Do You Know Where Your SBC Is?” (live on June 16).

Contributing Editors: EBIA Staff.