Summary of Benefits and Coverage Final Rule

KEY TAKEAWAY: A new regulation has been issued on the Summary of Benefits and Coverage (SBC) requirements for Health Insurance Issuers. The SBC tool is an easy-to-read summary of health insurance plan benefits and cost-sharing requirements that allows consumers to compare different health insurance plans (See a definition for SBC on HealthCare.gov). This new regulation includes several improvements to the SBC requirements that assisters should be aware of and help consumers to understand and benefit from. Please see the text below for details; there is also a link to a fact sheet that will allow you to learn more about what this new regulation means for consumers.

On Friday, June 12, 2015, the Departments of Health and Human Services (HHS), Labor, and the Treasury issued final regulations on the Summary of Benefits and Coverage (SBC). These final rules revise the current SBC regulations to make it easier for people and employers to compare their options when shopping for and renewing health insurance coverage, and they enhance the consumer shopping experience in a number of ways. For example, health insurance issuers must now provide online access to a copy of the individual coverage policy for each plan or group certificate of coverage.  And these documents must be made publicly available to all potential consumers prior to when a consumer applies for coverage, so they are clearly informed about what a plan will and will not offer.

Resources:

  • Click here for a Fact Sheet detailing consumer protections provided in these rules, and click here to view a press release with additional information on this announcement.
  • Click herefor consumer-friendly information about SBC’s on HealthCare.gov
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