Risk & Business Magazine Spectrum Insurance Magazine Fall 2017 | Page 30

REQUIRED FOR 2018 ENROLLMENT
New Summary
of Benefits and
Coverage Template
Required for 2018
Open Enrollment
BY: kate banchy ,
SPECTRUM INSRUANCE
O
VERVIEW
The updated template and
related materials for the
summary of benefits and
coverage (SBC) are required to be used for
annual open enrollment periods beginning
on or after April 1, 2017. For calendar
year plans, this means that the updated
template must be used for the 2018 open
enrollment period.
The SBC is a concise document providing
simple and consistent information about
health plan benefits and coverage. It
is intended to help consumers better
understand their coverage and to make it
easy to compare different options when
shopping for new coverage.
ACTION STEPS
Employers should prepare to use the new
SBC template and related materials for the
2018 open enrollment period. Prior to the
beginning of the 2018 open enrollment
period
self-funded plan sponsors should
ensure that they are using the new
template, and
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employers with insured plans should
make sure the carrier is providing the
correct version of the template.
BACKGROUND
The Affordable Care Act (ACA) requires
both grandfathered and nongrandfathered
health plans and health insurance issuers
to provide an SBC to applicants and
enrollees, free of charge. The SBC must be
produced in accordance with the applicable
template. Form language and formatting
must be precisely reproduced unless
instructions allow or instruct otherwise.
Unless otherwise instructed, the plan or
issuer must use 12-point font (as required
by federal law) and must replicate all
symbols, formatting, bolding, and shading.
The Departments of Labor (DOL) and
Health & Human Services (HHS) issued
the updated SBC template and related
materials on April 6, 2016:
Plans with annual open enrollment
periods must start using the new
template on the first day of the first
open enrollment period that begins
on or after April 1, 2017, with respect
to coverage for plan or policy years
beginning on or after that date.
Plans without an annual open
enrollment period must start using
the new template on the first day of
the first plan or policy year that begins
on or after April 1, 2017.
KEY CHANGES TO THE SBC TEMPLATE
AND INSTRUCTIONS
The new template is five pages long (two
and one-half double-sided pages), which is
shorter than the prior six-page version. The
updated template and instructions also
differ from the prior versions as follows:
INTRODUCTION
The revised SBC contains a new
introductory paragraph that provides
information about the purpose and
structure of the SBC. The introduction
also links to the uniform glossary. In the
introduction and throughout the SBC,
terms defined in the uniform glossary are
hyperlinked directly to the definitions in
electronic versions of the SBC.
IMPORTANT QUESTIONS
The “Important Questions” section was
revised to include a question about services
covered before the deductible is met.
Questions about annual limits and services