The departments of Labor, Health and Human Services, and Treasury issued a set of 14 frequently asked questions (FAQs) and answers regarding implementation of the summary of benefits and coverage (SBC) provisions of the Affordable Care Act (ACA). Importantly in the FAQs, the departments announced that they would not take enforcement action against insurers in a number of circumstances for failure to fully comply with requirements that they provide a standardized SBC during the first year of applicability of the new rules.
The departments issued a final rule in February requiring insurers to use plain language in describing benefits and coverage. With the final rule, the departments released a uniform glossary of terms.
The guidance is the ninth set of FAQs posted regarding ACA compliance. This set of FAQs also addresses when plans and issuers can provide SBC electronically, circumstances that will trigger the requirement for an issuer to provide an SBC, and whether issuers are required to provide SBCs to group health plans or their sponsors that are shopping for coverage but have yet to submit an application.
May 29, 2012
Research has found that consumers have significant difficulty understanding health insurance plans. This can prevent consumers from receiving clear information regarding their health insurance plan benefits. Without a clear understanding of what their insurance covers, consumers are more likely to delay or forgo care, to make uninformed choices about treatment, and to end up with large and unexpected bills.
The Affordable Care Act (ACA) will give consumers the...
March 9, 2012
The Affordable Care Act included a number of insurance market reforms designed to make health insurance more affordable and available. During consideration of the ACA, one criticism of the private insurance market was that the lack of standardization in descriptions of health insurance policies available made shopping for coverage both difficult and time consuming. The ACA included provisions designed to assist consumers in better understanding their health insurance coverage, and to assist in comparing their insurance policy with other available options. Among those provisions are requirements for plans offered in both the group and individual insurance markets to provide a summary of benefits and coverage and a uniform glossary of terms commonly used in health insurance policies.
September 30, 2011
The Affordable Care Act (ACA) included a new requirement that health plans in the group and individual markets disclose plan information to consumers in a standardized, accessible format in order to facilitate comparison of plans and improve understanding of plan terms. On August 22, 2011, several federal agencies jointly issued a notice of proposed rulemaking (NPRM) setting forth proposed disclosure requirements, including templates for the disclosures. Comments are due on October 21, 2011.