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Agencies Plan to Issue Summary of Benefits and Coverage Final Rules

On March 31, 2015, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury issued a Frequently Asked Questions (FAQ) announcing their intention to issue final regulations on the SBC requirement in the near future. These regulations would finalize proposed changes in the proposed regulations from December 22, 2014, which were proposed to apply beginning September 1, 2015. However, the FAQ notes that the final rules are expected to apply in connection with:

  • Coverage that would renew or begin on the first day of the first plan year (or policy year, in the individual market) that begins on or after January 1, 2016; or
  • Open enrollment periods that occur in the fall of 2015 for coverage beginning on or after January 1, 2016.

Despite this effective date, the new template, instructions and uniform glossary are not expected to be finalized until January 2016. According to the Departments, this delay is necessary to allow for consumer testing and offer an opportunity for the public to provide further input before finalizing revisions to the SBC template and associated documents. The revised template and associated documents will apply to:

  • Coverage that would renew or begin on the first day of the first plan year (or policy year, in the individual market) that begins on or after January 1, 2017; or
  • Open enrollment periods that occur in the fall of 2016 for coverage beginning on or after January 1, 2017.

Impact on Employers

This FAQ guidance leaves a lot of uncertainty for employers with regard to their SBC documents. The changes included in the final regulations may require health plans to update their SBC documents before the new template is released.

The forthcoming final regulations may address this issue. In some cases, the Departments have provided temporary enforcement safe harbors when guidance is not issued sufficiently in advance of an effective date. However, at this time, no safe harbors or other relief have been provided on this issue.

Learn more by reading our full Healthcare Reform Legislative Brief.