Agencies Revise ACA Summary of Benefits and Coverage



Federal agencies finalized a new version of the summary of benefits and coverage and uniform glossary that health plans must provide consumers under the Affordable Care Act.

The templates, instructions and related materials were released by the departments of Health and Human Services, Labor and Treasury on April 6 with several additions. 

In a release, HHS said changes were made to the disclosures to improve “readability” for consumers. The new templates include more information about cost sharing, such as language to explain deductibles and a requirement that plans address individual and overall out-of-pocket limits, reflecting input from consumer groups and the National Association of Insurance Commissioners.

Plans that are looking to add more tech-savvy flourishes to their SBC may add embedded hyperlinks and text bubbles, the SBC instructions said. While not required, plans that provide consumers with an electronic SBC may hyperlink defined terms directly to the uniform glossary or add a hover text application that shows defined terms in a text bubble.

The agencies also added an example of a simple foot fracture to the Guide for Coverage Examples Calculation, which previously included a maternity scenario and diabetes scenario.

Health plans and health insurance issuers offering group or individual health insurance coverage must provide consumers with a SBC and uniform glossary under June 2015 final rules (Treasury T.D. 9724, DOL RIN 1210-AB69, HHS CMS-9938-F).

SBCs, which are essentially a distillation of a Summary Plan Description, should include a brief summary of what the plan covers and the cost sharing responsibility of the consumer. The uniform glossary should include a comprehensive list of common insurance-related and medical-related terms.

The documents are meant to help consumers compare plan coverage.

Plan sponsors must begin using the new SBC materials and supporting documents on the first day of the first open enrollment period beginning on or after April 1, 2017. Until then, plans may use the documents released in April 2013 that went into effect on or after Jan. 1, 2014.

More information on the summary of benefits and coverage is available at and

See related story, New Health Plan Summary Disclosure Requirements Released.

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