New Summary of Benefits and Coverage Information, Including Templates

The U.S. departments of Labor (DOL), HHS and Treasury jointly issued Frequently Asked Questions (FAQs) on April 23, providing seven new questions and answers covering the implementation of the Summary of Benefits and Coverage (SBC) requirements under the ACA. The SBC is intended to provide consumers with consistent and comparable information regarding health plan benefits and coverage.

Along with the FAQs, the departments issued updated versions of the official template and completed sample, authorized for the second year of applicability of the SBC requirements (coverage beginning on or after January 1, 2014, and before January 1, 2015). The only change to the SBC template and sample completed SBC is the addition of data elements indicating whether the plan or coverage provides minimum essential coverage (MEC) and whether the plan or coverage meets the minimum value (MV) requirements. These MEC and MV requirements are what determines whether a plan offered by an employer meets the test for avoiding a penalty payment under the shared responsibility ("pay or play") provision of the ACA.

The guidance also provides relief to plans that are already in the process of preparing its SBC for the second year of applicability and for whom it would be an administrative burden to add the new data element. In such cases, the departments “will not take any enforcement action against a plan or issuer for using the template authorized for the first year of applicability, provided that the SBC is furnished with a cover letter or similar disclosure stating whether the plan or coverage does or does not provide MEC and whether the plan’s or coverage’s share of the total allowed costs of benefits provided under the plan or coverage does or does not meet the MV requirement under the Affordable Care Act.”