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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