Close Close

Life Health > Health Insurance > Health Insurance

The Catch: SBC? What's That?

Your article was successfully shared with the contacts you provided.

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.


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.

More on this topic

The company also is testing patient-centered medical homes — efforts to help primary care providers take care of wellness and condition management services — in 13 states, and it will be participating in 8 to 12 accountable care organization pilot projects, Sandy said.

UnitedHealth already has found by looking at its quality data that cardiologists who earn a designation for providing high-quality care have a 55% lower complication rate for stent placement procedures than cardiologists who did not receive the quality designation, Sandy testified according to a written version of his testimony posted on the committee website.

Dr. David Share of Blue Cross Blue Shield of Michigan Detroit, also talked about the need for quality and efficiency incentives, but he said performance should be measured at the physician organization level.

“Measuring performance at the individual physician level is fraught with methodological limitations,” such as variability in patient characteristics, Share said.

Dr. Len Nichols, a health policy researcher at George Mason University, said carriers need Medicare managers to help push for reimbursement changes.

“While it has not gotten enough policy attention yet, there is growing awareness that a serious problem private insurers face in many markets is loal provider market power,” Nichols said

Only Medicare has enough market share to take on the biggest providers, Nichols said.


AIG Benefit Solutions, Neptune, N.J., has made critical illness insurance one of the core products in three new voluntary benefits packages aimed at employers with 2 or more covered lives.

AIG Benefit Solutions a unit of American International Group Inc., New York (NYSE:AIG), is putting critical illness insurace in all three of the packages, along with term life insurance and accident insurance.

A mid-level packages comes with those products and short-term disability (STD) insurance.

The deluxe package comes with the core benefits, STD coverage and vision insurance.