The document implements the disclosure requirements under section 2715 of the Public Health Service Act to help plans and individuals better understand their health coverage, as well as other coverage options. The final regulations apply for disclosures to participants and beneficiaries who enroll or re-enroll in group health coverage through an open enrollment period (including re-enrollees and late enrollees) beginning on the first day of the first open enrollment period that begins on or after September 23, 2012.
For disclosures to participants and beneficiaries who enroll in group health plan coverage other than through an open enrollment period (including individuals who are newly eligible for coverage and special enrollees), the requirements under PHS Act section 2715 and these final regulations apply beginning the first day of the first plan year that begins on or after September 23, 2012.
For disclosures to plans, and to individuals and dependents in the individual market, these requirements are applicable to health insurance issuers beginning September 23, 2012.
Read the final regulations in their entirety by visiting http://www.dol.gov/ebsa/pdf/SBCfinalreg.pdf.
EBSA also provided the following updates:
• Compliance Guide: www.dol.gov/ebsa/pdf/SBCguidance.pdf
• Summary of Benefits and Coverage Template: www.dol.gov/ebsa/pdf/SBCtemplate.pdf
• Sample Completed SBC: www.dol.gov/ebsa/pdf/SBCSampleCompleted.pdf
• Instructions for Completing the SBC - Group Health Plan Coverage: www.dol.gov/ebsa/pdf/SBCInstructionsGroup.pdf
• Instructions for Completing the SBC - Individual Health Insurance Coverage: www.dol.gov/ebsa/pdf/SBCInstructionsIndividual.pdf
• Why This Matters language for "Yes" Answers: www.dol.gov/ebsa/pdf/SBCYesAnswers.pdf
• Why This Matters language for "No" Answers: www.dol.gov/ebsa/pdf/SBCNoAnswers.pdf
• HHS Information for Simulating Coverage Examples: http://cciio.cms.gov/resources/other/index.html#sbcug
• Uniform Glossary of Coverage and Medical Terms: www.dol.gov/ebsa/pdf/SBCUniformGlossary.pdf
• Automatic Enrollment, Employer Shared Responsibility and Waiting Periods Technical Release 2012-01: http://www.dol.gov/ebsa/newsroom/tr12-01.html
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