Affordable Care Act SBC and Uniform Glossary: Final Rules Issued for 2017 Coverage

The Summary of Benefits and Coverage (SBC) is an Affordable Care Act-required notice health insurance issuers and group health plans must provide to their employees. It includes coverage examples and a uniform glossary.

Final Rules on the contents of the SBC and Uniform Glossary were recently released by the Departments of Health and Human Services (HHS), Labor (DOL), and the Treasury. The new rules allow streamlined processes to help issuers of health care and group health plans provide consumers easy-to-understand information.

Key policies in the final rules:

  • Provision to Require Online Access to Individual Underlying Policy or Group Certificate:
    For group coverage, the insurer must post on the Internet a copy of the group certificate of coverage where it is easily available to plan sponsors, participants, and beneficiaries.
  • Provisions to Reduce Unnecessary Duplication: A group plan using a binding contractual arrangement where another party (e.g., insurer) assumes responsibility for providing the SBC will not also need to provide the SBC themselves.
  • Provision to Require Certain Disclosures by Qualified Health Plan (QHP) Issuers:
    QHP issuers must disclose on the SBC whether non-excepted abortion services as well as excepted abortion services (that is, those abortion services for which public funding is permitted) are covered or excluded.

Revisions to the language of the SBC, coverage examples, and uniform glossary are anticipated to be finalized by January 2016 after testing and input from the public, for use beginning on or after January 1, 2017.

The jointly released final rules summary may be read here.