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September 24, 2012 at 10:53 AM
U.S. employers, health insurers and plan advisors now have to comply with the “health insurance nutrition label rules”—the “summary of benefits and coverage” (SBC) rules.
The rules, part of the Patient Protection and Affordable Care Act of 2010 (PPACA), are supposed to help consumers and employers shop for high-quality health coverage by giving them the nuts-and-bolts plan information they need to compare the value of the benefits provided as well as the premiums.
An SBC is supposed to describe the basic features of an individual policy or group plan and also provide detailed, standardized examples showing how the plan would work in two sample scenarios: Having a baby or dealing with diabetes.
Insurers and employers are supposed to make the SBCs available free of charge when consumers are shopping for, enrolling in or renewing coverage.
The SBCs must be available during the next open enrollment period that started on or after Sept. 23, 2012. For consumers who enroll outside an open enrollment period, the SBC must be available at the start of the next plan year that begins on or after Sept. 23, 2012.
Health and Human Services (HHS) officials developed the SBC program together with officials from the U.S. Labor Department, the Internal Revenue Service and state insurance commissioners.
Analysts at the Henry J. Kaiser Family Foundation found when they surveyed consumers about the SBC concept that 76 percent of the Republicans polled liked the idea, even though many of those Republicans said they oppose PPACA.
Insurance groups and other groups that say they like the SBC concept have argued that the SBC rules could backfire, by making SBCs a nightmare for employers, insurers and benefit plan administrators to produce.
For now, at least, PPACA proponents are hailing the SBC effective date as a PPACA implementation success story.
