Obama Administration Issues Final Rules on ACA Summary of Insurance Benefits/Uniform Glossary Provisions

On February 14, 2012, the Departments of Health and Human Services (HHS), Labor, and Treasury pulbished  final rules designed to help consumers understand and evaluate their health insurance options, as mandated by the ACA. The first rule requires health plans and issuers to provide consumers with a Summary of Benefits and Coverage (SBC) outlining key features of the plan or coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions. The SBC also will feature a standardized plan comparison tool with coverage examples illustrating the extent of coverage and costs for sample medical situations. Health plans and issuers must provide notice at least 60 days before any significant modification is made in the plan or coverage during the year. The regulation also establishes a uniform glossary of terms commonly used in health insurance coverage (e.g., coinsurance, deductible, excluded services, and out-of-network). The rule generally applies to disclosures to participants and beneficiaries who enroll or re-enroll in group health coverage through an open enrollment period beginning on or after September 23, 2012. Second, the Departments have released templates and instructions to be used in making required disclosures under the SBC rule.

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