Proposed Rules for Summary of Benefits and Coverage

2011-09

The Patient Protection and Affordable Care Act (ACA), passed in March 2010, required the Department of Labor, the Department of Health and Human Services and the Internal Revenue Service (collectively, "the agencies") to issue regulations describing the "Summary of Benefits and Coverage" that ACA created.  In Late August 2011 the agencies issued proposed rules for the Summary and for a uniform glossary of terms.  These are proposed rules (as opposed to interim or final rules) and the agencies have allowed until October 21, 2011 for comments on the proposed rules before making them final.  Thus, it is possible that some parts might change.
 
ACA requires all group and individual health plans and insurance policies to use the Summary of Benefits and Coverage form and the uniform glossary to describe the benefits in a way that may be understood by consumers who are or are considering being covered by a health plan.  The idea is to give consumers an "apples to apples" comparison of different plans.
 
The proposed rules lay out very specific length, appearance and format instructions and specify when and to whom the Summary must be given.  It also requires plans to change and redistribute the Summary at least 60 days before the effective date of any material change to benefits that are included in the Summary.  
 
The deadline for generating the Summary, according to ACA, is March 23, 2012.  Since that is only six months away, the final rules might delay that effective date or allow a phase-in period.  To view the proposed rules click the link below.
 
When the comment period is over and the rules are finalized, ACS will post more details on the new requirements.

http://www.dol.gov/ebsa/healthreform/index.html#2715