Even the government has a hard time getting its Summaries of Benefits and Coverage (SBC) perfect.
Officials from the U.S. Department of Labor, the U.S. Department of Health and Human Services and the U.S. Treasury Department admit as much in a new batch of answers to frequently asked questions about implementation of the Patient Protection and Affordable Care Act of 2010 (PPACA).
Most of the answers are responses to questions about SBCs and a related document, a “uniform glossary” of health benefits terms.
Congress included the SBC and glossary requirements in PPACA in an effort to help consumers understand their health coverage better and do a better job of shopping for coverage.
An SBC is supposed to include a summary of basic plan features, along with coverage examples, or “scenarios,” that show how a plan would work if an enrollee had a baby, were managing Type II diabetes, or were dealing with other common illnesses, chronic conditions or life events.
Consumers will get SBCs when they apply for coverage or enroll in group plans. Consumers also can get SBCs upon request.
The SBC requirements are set to take effect Sept. 23 for individual coverage and for group plan open enrollment periods that begin on or after Sept. 23.
Officials note that one of the questions often asked deals with just how aggressive regulators will be about throwing the book at health insurers, employers, plan administrators and others that fail to meet SBC and glossary requirements.