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South Dakota patches PPACA benefits summary hole

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Merle Scheiber has stepped up to fix a gap in the new federal “summary of benefits and coverage” (SBC) rules.

The rules, part of the Patient Protection and Affordable Care Act of 2010 (PPACA), require health insurers and group health plans to start providing SBCs for any coverage that started to take effect after Sept. 23.

The PPACA SBC rules 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.

One challenge: The SBC rules do not say anything about whether insurers or group health plan sponsors or administrations have to mention the price of the coverage, or anything else about the price of the coverage.

Scheiber, the South Dakota insurance director, has tackled the SBC price information hole in South Dakota Insurance Regulatory Bulletin 12-05.

“Unfortunately, the SBC does not contain all of the required disclosures necessary to comply with both PPACA and those state and federal requirements that were already in place,” Scheiber wrote in the letter.

The current SBC rules do not reflect another federal law that requires issuers to disclose that they have the right to change their premium rates, Scheiber said.

“Since this disclosure is not found in the SBC, and the SBC cannot be modified to include this disclosure, a separate disclosure of the right to change premiums is required,” Scheiber said.

The South Dakota Division of Insurance will let insurers provide the rate disclosure in any type of supplemental document, Scheiber said.

The supplemental disclosure could be a stand-alone document or incorporated into any other document other than the SBC, Scheiber said. 

Insurers do not have to file the supplemental disclosure forms with the South Dakota division, Scheiber said. 

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