The U.S. Department of Health and Human Services (HHS) has been having trouble with setting final requirements for the sleek new sister of the summary plan description (SPD) — the summary of benefits and coverage (SBC).
Given how far behind HHS is, it’s pretty much a given that employers will be slow to develop SBC programs.
HighRoads Inc., Woburn, Mass., is reporting that only 48% of the large and midsize employers tht participated in an informal survey expect to have SBCs ready by March 31. Another 43% will be waiting until the next open enrollment rolls around to get SBCs out, and the rest aren’t sure what they’ll do.
An SPD is a relatively long, complicated document that is supposed to explain a benefit plan to the emloyees in plan.
Congress created the SBC, a supplement to the SPD, with a provision in the Patient Protection and Affordable Care Act of 2010 (PPACA) that requires plans to provide a standardized, 4-page document that explains what a health insurance plan will do in terms that a consumer can understand. One section of the SBC is supposed to help consumers compare the out-of-pocket costs associated with a plan by showing, for example, how a plan might cover sample conditions and procedures, such as an uncomplicated pregnancy.
Back in August 2011, HHS officials announced that employers and insurers should be ready to provide SBCs by March 23, 2012.
But HHS kept pushing back the completion date for final SBC regulations. The current estimated time of arrival is April 13. HHS has said it will give employers some time after the final regulations come out to implement the SBC requirements.
HighRoads, an SPD company, says the new SBC requirements are coming out at a time when employers’ benefits managers are facing pressure to cut document production costs.
HighRoads is hoping the combination of new SBC requirements and cost-cutting pressure will lead more employers to hire outside companies to produce their SPDs and SBCs.
DR. GREEN TO THE RESCUE
The Health Ways and Means Health Subcommittee today held a hearing on the idea that changing physician reimbursement strategies could help control U.S. health costs.
Dr. Lewis Sandy, a senior vice president at UnitedHealth Group Inc., Minnetonka, Minn. (NYSE:UNH), talked about his company’s to reward physicians for providing efficient, high-quality care.
The company has developed a diabetes program, for example, that provides incentives for physicians who help patients with diabetes stick with the recommended care plan.