Providing the SBC

        Final Rule Updates SBC Requirement


The final regulations provide additional guidance on when a plan or issuer must provide the SBC to participants and beneficiaries. For example, the final regulations clarify how to satisfy the requirement to provide an SBC in the following situations:

     • The issuer provides the SBC upon request before application for coverage—
     If the issuer provides the SBC upon request before application for coverage, the
     requirement to provide an SBC upon application is deemed satisfied, and
     the issuer is not required to automatically provide another SBC upon application
     to the same entity or individual (provided there is no change to the information
     required to be in the SBC). However, if there has been a change in the
     information required to be included in the SBC, a new SBC that includes the
     changed information must be provided upon application (that is, as soon as
     practicable following receipt of the application, but in no event later than
     seven business days following receipt of the application).

     • The terms of coverage are not finalized—If the plan sponsor is negotiating
     coverage terms after an application has been filed and the information
     required to be in the SBC changes, an updated SBC is not required to be provided
     to the plan or its sponsor (unless an updated SBC is requested) until the first day of
     coverage. The updated SBC is required to reflect the final coverage terms under
     the policy, certificate, or contract of insurance that was purchased.

On June 16, 2015, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) published final regulations on the summary of benefits and coverage (SBC) and uniform glossary requirement under the Affordable Care Act (ACA).

These regulations finalize provisions in proposed regulations that were published on Dec. 30, 2014, in order to amend prior final regulations from Feb. 14, 2012. According to the Departments, the changes made by these final regulations are designed to improve consumers’ access to important health plan information and to provide clarification that will make it easier for group health plans and health insurance issuers to comply with the SBC requirement.