New SBC Template Required For Use On or After April 1

New versions of the Summary of Benefits and Coverage (SBC) template, instructions, uniform glossary, and related documents are required for use on or after April 1, 2017. Under the Affordable Care Act, group health plans and health insurance issuers are generally required to provide a written SBC to plan participants and beneficiaries at specified times during the enrollment process and upon request.

Changes to SBC Template

The new SBC template includes an additional coverage example as well as language and terms to improve individuals’ understanding of their health coverage. Specifically, the new template includes more information about cost sharing, such as enhanced language to explain deductibles, and requires plans to address individual and overall out-of-pocket limits. Changes have also been made to the SBC to improve readability.

Implementation Date for Using New Template and Related Documents

The implementation date for using the new SBC template and associated materials will be as follows:

• Health plans and issuers that maintain an annual open enrollment period will be required to use the new editions beginning on the first day of the first open enrollment period that begins on or after April 1, 2017 with respect to coverage for plan years beginning on or after that date.

• Health plans and issuers that do not use an annual open enrollment period will be required to use the new editions beginning on the first day of the first plan year that begins on or after April 1, 2017.

Click here to access the new SBC template and related materials.

Additional information can be found in our Summary of Benefits and Coverage (SBC) section.