One of the new requirements in PPACA healthcare reform is that insurers must provide a “Summary of Benefits and Coverage” (SBC). This is in addition to the other required plan documents, and the reason for this new document is so that individuals and businesses who are trying to compare plans across different carriers may do so more easily. Insurance plans renewing on or after 9/23/2012 must provide a document with these components:
<1> The summary of benefits section has required content, including deductible, copays, etc. There is a pre-determined format, no more than 4 pages, double-sided, and MUST be in 12 point font. It tells the plan features, and then why it is important. The HHS will determine by zip code which languages are most prevelant, and determine if a second language version will be required. The insurer provides this to the employer, and the employer must distribute it via a technolgically appropriate means to all insureds.
<2>The next section includes coverage facts for two diagnoses: a) normal child birth and b) managing type 2 diabetes. This section will indicate how the plan would work in covering these expenses. The HHS intends to add more diagnoses over time. Here is a sample completed SBC: http://www.dol.gov/ebsa/pdf/SBCSampleCompleted.pdf
<3>Uniform glossary of terms to explain what things like “copay” and “allowed charges” mean. Here is the template for that: http://www.dol.gov/ebsa/pdf/SBCUniformGlossary.pdf
<4>Notice of modification – 60 days prior to a change in the plan, insureds must be given notice.
Hopefully this will help people to better understand their benefits, and what to expect when they receive care. This is a positive thing in my mind!