Proposed changes to the Affordable Care Acts summary of benefits and coverage and uniform glossary are coming under fire from business groups who say the implementation time frame does not give them enough time to comply with the new requirements.
The SBC, mandated by the ACA, is intended to provide group health plan members with an easy-to-understand summary of a health plans benefits and coverage. Its an additional document employers have to ensure employees receive, above and beyond whatever other communications they provide. Under the current rules, it can be no longer than four double-sided pages and must include two standard coverage examples having a baby and managing type 2 diabetes using specific words contained in the glossary.
The new rules, proposed late December by the Departments of Labor, Health and Human Services and the Treasury, propose to cut the length of the SBC to two pages, increase the number of coverage examples to three, revamp how cost estimates included in the SBC are done and simplify the times when the SBC needs to be distributed.
The proposed rule provides that the changes would apply beginning the first day of the first open enrollment period beginning on or after Sept. 1, 2015 for plan participants who enroll or re-enroll in group health coverage through open enrollment. For participants and beneficiaries enrolling in coverage at a time other than during open enrollment, the changes would apply on the first day of the first plan year beginning on or after Sept. 1, 2015.
Fully insured employers generally rely on their insurers to provide the SBC. Self-funded employers, meanwhile, may create the SBC themselves, or rely on their third-party administrators.
The applicability date in the Proposed Rule does not allow plans and issuers sufficient time to update their internal processes to comply with the Proposed Rules new requirements or changes in the SBC template, said the American Benefits Council in its comment letter to the Employee Benefits Security Administration. The comment period closed March 2.
The National Business Group on Health, meanwhile, in its comment letter recommended EBSA delay the effective date of the SBC and uniform glossary requirements to the first day of the first plan year beginning 12 months after the issuance of final regulations.
Also see: Feds issue regs on SBC requirement
Its a government-prescribed form and sometimes its not very effective and can be confusing for employees, says Steve Wojcik, vice president, public policy, with the NBGH. The employer has to send it, and draw attention to it, but then is also saying by the way, heres our communications about benefits. Its duplicative.
The NBGH is asking for more flexibility to allow the information to be incorporated into employers current plan communications and summary plan descriptions required under ERISA.
Its a good intention, but its too prescribed, believes Wojcik, adding the SBCs intent is for employees to be able to make an apple-to-apple comparison among various health plans that are available to them, but that the federal government doesnt realize employer plans dont necessarily fit the template theyre prescribing.
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