Department of Labor buildingThe Departments of Health and Human Services and Labor have issued updated templates for Summary of Benefits & Coverage (SBC). The Affordable Care Act requires self-funded health plans and insurers to provide an SBC every year to help employees make informed plan choices and better understand their coverage.
The new templates are required for use as early as January 1, 2021 and are based on the plan year – so, for example, if your plan runs on a June plan year, the new template is not required until June.
Notable changes to the SBC include:
A PRA Disclosure Statement has been added to the end of the second to last page of the document. This statement addresses a provision of the Paper Reduction Act that lets SBC recipients know they are not required to respond to the collection of information being displayed in the SBC. It also provides contact information in the instance a recipient has comments or suggestions on improving the form.
The Coverage Examples that appear on the last page of the document have been modified to reflect changes in the cost of medical services that occur over time due to inflation and other factors.
  • Diabetes Example: The total amount of expenses incurred for “Joe,” who’s managing his type 2 diabetes, has decreased.
  • Fracture Example: The total amount of expenses incurred by “Mia,” who visited the emergency room for a simple fracture, has increased.
  • Maternity Example: The costs incurred during “Peg’s” hospital stay has been modified to remove the separate newborn charges. The deductible line of the example should now match your deductible amount (if applicable).
If you have questions or comments regarding the SBC, or specific questions as to what exactly changed in the coverage examples to cause the increase or decrease in total costs, please contact your Account Management team.