Based on a review of 35 major health plan websites, most issuers are still struggling to provide the Summary of Benefits and Coverage, even while the SBC provision of the Patient Protection and Affordable Care Act took effect last week, according to Tyrula LLC.

The law requires insurers to provide a paper SBC document within seven days of application, renewal, or the first day of coverage.

"It's not surprising that a high percentage of health plans have not made their SBCs available online,” said Manu Uppal, CEO and co-founder of Tyrula. “Creating SBCs is not an easy task. An AHIP study from last year predicted $194 million in annual ongoing operating costs for all insurance plans to comply with the SBC regulation. Many companies may have taken a 'wait-and-see' approach and are planning to be compliant by October 2013."

According to Tyrul, 61.5% of insurers did not offer SBCs online. Of the 35 insurers reviewed, 36% had more than 5 million members; 36% had between one million and five million members; 28% had fewer than 1 million members.

“Tyrula assumed that the first set of SBCs a health plan would generate would address their individual plan types. As most insurance plans have an online application process, Tyrula also assumed they would make the SBCs available online,” the company said in a press release. “Tyrula targeted individual plans and applied as a single male born in 1980 who doesn't consume tobacco. Observations were made to see if an SBC could be easily located on each carrier's public site,” the company said in a press release.

During the first year of applicability, Tyrula said the U.S. Department of Labor will not impose penalties on plans and insurers that are working diligently and in good faith to comply. Tyrula will continue to monitor the adoption of SBCs and expand the scope of its analysis to include a review of the accuracy of the SBCs, plans that modified their SBCs, and the availability of SBCs online.

Chris McMahon is the senior editor of Insurance Networking News, a SourceMedia publication.


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