Summary of Benefits and Coverage, Uniform Glossary Rules Changes Proposed

Author: Ashley Shaw, XpertHR Legal Editor

January 6, 2015

The Departments of Health and Human Services, Labor and Treasury have released proposed regulations regarding the summary of benefits and coverage (SBC) and the uniform glossary for group health plans and health insurance coverage in the group and individual markets. The proposed rules would alter the regulations published on February 14, 2012. If passed, the new regulations would be available to consumers for coverage beginning on or after September 1, 2015.

The proposed changes to the SBC include requiring individual market qualified health plan issuers to disclose coverage of abortion. In addition, a third coverage example regarding a foot fracture leading to an emergency room visit would be added to the SBC.

The proposed regulations are also intended to clarify when an SBC should be provided if it was previously provided before application to any entity or individual. The proposed rules also address how to satisfy the requirement to provide an SBC when terms of coverage are not finalized.

The proposed regulations would add new words and definitions to the uniform glossary, including the following:

  • Individual responsibility requirement;
  • Cost-sharing requirement;
  • Claim; and
  • Screening.

Employers are invited to comment on the proposed rules by March 2, 2015. Comments should be submitted in the manner listed in the proposed regulations (i.e., either posted to the online Federal eRulemaking Portal or by mail or hand delivery) and should not contain personal information or information that the commenter would not want to become part of the public record. Any comments received by the Departments will be published on the internet without change.

A full copy of the proposed regulations, including portions not discussed here, may be found in the Federal Register.