REQUIRED FOR 2018 ENROLLMENT not covered have been deleted , although the SBC still includes information on services that are not covered in a separate section . Questions regarding out-ofpocket limits and network providers were rephrased to help consumers better understand plan terms .
DISCLOSURES The SBC contains information regarding continuation coverage and grievance and appeal rights . These disclosures were revised in the updated template . The SBC also contains information on whether the plan provides minimum essential coverage and minimum value . This information must be provided as a “ yes ” or “ no ” answer along with specific language regarding potential tax consequences for the individual .
COVERAGE EXAMPLES The SBC includes coverage examples that demonstrate the cost-sharing amounts an individual might be responsible for in three common medical situations . In addition to the existing coverage examples that address diabetes care and childbirth , the updated template includes a new coverage example that addresses coverage for a foot fracture in order to provide information about what a plan covers in an emergency scenario . The page regarding assumptions and other information about the examples was eliminated .
INSTRUCTIONS The instructions provide additional information regarding permissible font types and margin adjustments . Also note that the SBC must not exceed four doublesided pages . The instructions retain the special rule that , to the extent that a plan ’ s terms cannot reasonably be described in a manner consistent with the template and instructions , the plan or issuer must accurately describe the relevant plan terms while using its best efforts to do so in a manner that is still as consistent with the instructions and template format as reasonably possible .
The instructions also provide additional flexibility under the special rule for combining information on different costsharing selections or add-ons to major medical coverage ( such as health flexible spending accounts , health reimbursement arrangements , health savings accounts , or wellness programs ) in one SBC . The information must be understandable if it is combined . +
MORE INFORMATION For more information on the updated SBC template and related materials — such as the instructions for completing the SBC — see the DOL or HHS websites :
DOL : http :// www . dol . gov / ebsa / healthreform / regulations / summaryofbenefits . html
HHS : https :// www . cms . gov / cciio / Resources / Forms-Reports-and-Other- Resources /
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