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Feds hope to shift to new SBC standard April 1, 2017

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Federal regulators may give the typical major medical plan an extra year to switch over to a new version of the Summary of Benefits and Coverage (SBC).

Drafters of the Patient Protection and Affordable Care Act (PPACA) wanted the SBC to serve as a simple, standardized “milk carton label’ for health plans.

Back in March 2015, the PPACA “tri-agency” team — the Internal Revenue Service (IRS), the Employee Benefits Security Administration (EBSA) and the U.S. Department of Health and Human Services (HHS) — said they wanted to get a revised version of the SBC into use by 2017.

See also: Health plan ‘carton labels’: Your last chance to comment on the new SBCs

In a new answer to frequently asked questions (FAQ), the tri-agencies say they still want to introduce the new SBC in 2017. But they now say they intend to apply the updated requirements to benefits summaries going out on or after April 1, 2017. 

For plans with a plan year that’s the same as the calendar year, managers won’t have to shift to the SBC II format until they start enrolling people in coverage for 2018.

The tri-agencies recently began putting the new SBC template and an update of a related document, the Uniform Glossary, through a public comment period. The public comment period ends March 28. The tri-agencies could respond to comments by changing the document templates or changing the rollout schedule.

The current SBC II draft includes more information about the coverage a plan might provide during the time before the insureds have met the deductible. The draft also includes a scenario showing how the plan might cover treatment of a simple fracture. The current SBC includes a diabetes scenario and a pregnancy scenario.

See also:

Feds aim benefits scenario at young invincibles

Plan ‘carton label’ changes could make pre-deductible benefits shine


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