The Centers for Medicare & Medicaid Services is trying to get the “in-person assisters” who help consumers sign up for exchange plans publicize the Summary of Benefits and Coverage program.
Consumers “have a right to receive an SBC from their insurance company or group health plan upon request at any time,” CMS says in a new SBC guide for assisters.
Drafters of the Patient Protection and Affordable Care Act created the SBC program in an effort to help consumers and employers compare PPACA-compliant major medical plans on an apples-to-apples basis.
A plan issuer is supposed to give a snapshot of how a plan would cover an insured who had a baby or was managing Type 2 diabetes.
The SBC is also supposed to give information about matters such as deductibles, out-of-pocket expense limits and specialist referral requirements.
Regulators have said they will focus on educating employers and insurers about the SBC requirements, not imposing fines. But regulators can impose penalties of up to $1,000 per day per affected individuals for what regulators view as “willful” failures to provide SBCs.
Under ordinary circumstances, regulators could impose penalties of $110 per affected employee per day for ordinary failures to meet the SBC requirements.