Changes to “Final” Summary of Benefits and Coverage

Although the government issued final regulations and templates for the Summary of Benefits and Coverage in February, the Department of Labor and Health and Human Services issued new guidance in April — and a new version of the template that must be used.

Quick background information
Health insurers and self-insured employers are required by the health care reform law to issue this Summary of Benefits and Coverage for group or individual health plans.

• These summaries explain in simple language the employee’s health plan and offer examples of how it works, following a government-approved template.
• The effective date is September 23, 2012.

What you need to know now
The updated information is available through the following links:

See the corrected template for the Summary of Benefits and Coverage and the sample of a completed form

• Read new frequently asked questions that include updated clarification on the Summary of Benefits and Coverage implementation
• Get information on the New HHS Guidance on the Inputs for the Coverage Example Calculator

Impact on employers — Plan administrators are charged with distributing compliant Summaries of Benefits and Coverage to employees with health coverage. Penalties for noncompliance can range from $100 to $1,000 per employee, with the highest fine for “willful” noncompliance. There are no penalties during the first year as long as the employer is working toward compliance.

Impact on brokers — Your customers may ask to see a Summary of Benefits and Coverage for a plan during the presale process. The regulations grant employers the right to this information before any application is signed. These may make it easier for you to help customers compare health plans “apples to apples.”

Impact on employees and individuals — The standard terms, simple language and everyday examples required for these communications will make it easier for consumers to understand their health coverage and its limits.