Final Regulations Issued on Summary of Benefits Coverage

On Feb. 9, the Employee Benefits Administration of the U.S. Dept. of Labor published final regulations on the Summary of Benefits Coverage (SBC). The four-page SBC is required by health care reform laws. This requirement was postponed until these regulations could be issued. Plans must now comply with the SBC requirement by the first day of the open enrollment period that begins on or after September 23, 2012.

The DOL estimates that the cost for plans to comply may be around $73 million. The hope is that the cost will be offset by efficiencies achieved for insurance companies and employers to compete and compare options on price, benefits, and quality. Required elements of the SBC are:

– Uniform definition of medical and health terms
– Description of the cost sharing requirements (deductibles, co-pays, and co-insurance)
– Information about exceptions, reductions, or limits
– Examples of coverage illustrating benefits covered under different scenarios
The SBC format must be uniform: four double-sided pages and no smaller than 12-point font.