The Affordable Care Act implemented a new requirement that all group health plans must provide an annual summary of benefits and coverage (SBC) to participants and beneficiaries in order to help individuals better understand the coverage and compare options. Group health plans of private, government and church employers all must comply with this requirement.
Insurers provide the SBC for fully insured plans, but the plan sponsor (i.e. the employer) must provide the SBC for self-insured plans. Employers do not need to provide an SBC for retiree-only plans. This SBC requirement has applied to group health plans since September 23, 2012.
In an effort to improve consumer access to plan information and make it easier for group health plans to comply with the SBC requirement, the Departments of Health and Human Services, Labor (DOL), and the Treasury (collectively, "Departments") issued final regulations (amending the prior final regulations published in 2012). These final regulations issued in June of 2015 announced that a new template and glossary would be released in January 2016.
In late February 2016, the DOL submitted a new proposed template and uniform glossary to the Office of Management and Budget (OMB) for consideration. The OMB considered comments through March 28, 2016 and approved a final version of the template and glossary. The DOL requested that OMB approve the template and glossary for a three-year period. The DOL indicated that health plans and issuers that maintain an annual enrollment period are required to use the new SBC template and associated documents beginning on the first day of the first open enrollment period that begins on or after April 1, 2017 with respect to coverage for plan years beginning on or after that date.
A Microsoft Word version of the new SBC template can be found at: www.dol.gov/ebsa/sbc-template-final.doc.
A PDF version of the new SBC template can be found at: http://www.dol.gov/ebsa/pdf/sbc-template-final.pdf.
The new Uniform Glossary is available at: http://www.dol.gov/ebsa/pdf/SBC-Uniform-Glossary-final.pdf.
Instructions for Completing the SBC Template are available at: http://www.dol.gov/ebsa/pdf/SBC-Instructions-Group-final.pdf.