Horizon Actuarial Services, LLC
  • Home
  • About Us
    • Horizon Updates
    • Selected Bios
  • Our Services
  • Resources
    • News
    • Publications
    • External Links
  • Careers
  • Contact Us

​

Proposed Regulations on Uniform Explanation of Coverage under PPACA

8/29/2011

 
On August 17, 2011, the Departments of Labor, Health and Human Services (HHS), and Treasury released proposed regulations regarding the Patient Protection and Affordable Care Act (PPACA) requirement to distribute a uniform explanation of coverage.  The new rules are intended to provide individuals with more useful information to enable them to better understand their options when making coverage and enrollment decisions.

Two New Forms

Under the new rules, health plans will be required to provide their participants with two new forms: (1) an easy-to-understand “Summary of Benefits Coverage” (SBC) and (2) a standard glossary of commonly-used health care plan terminology.  The new rules also require health insurers to provide these forms to their customers.

A notable requirement of the new SBC is that it must include “coverage examples” that describe coverage and cost sharing for certain common health care scenarios.  Currently, the three scenarios required on the SBC are having a baby, treating breast cancer, and managing diabetes.

A template of the SBC can be found on the Department of Labor website.  The four-page uniform glossary of terms that must be provided to all participants can also be found on the Department of Labor website.

Effective Date and Compliance

The new rules will take effect on March 23, 2012, and they will apply to all group health plans, both grandfathered and non-grandfathered.  Health plans must provide these new forms to participants as part of any package of materials that is sent to them prior to their first enrollment in coverage, and 30 days prior to their re-enrollment or renewal of coverage.  They must also provide the new forms upon request, within seven days.

If there is a material modification in any of the terms of the plan that would affect the content of the SBC, the plan must provide notice of the modification to enrollees not later than 60 days prior to the date on which such modification will become effective.

Plans may be imposed a fine of up to $1,000 for each instance of willful non-compliance. In calculating the amount of the penalty, each failure with respect to an individual participant or beneficiary is considered a separate offense.

Public Comment and Where to Get More Information

The proposed regulations are open to public comment through October 21, 2011.  For more information on making comments, refer to the proposed regulations.

A news release regarding the proposed regulations and other information (both regarding the proposed regulations and other aspects of PPACA) can be found on the Department of Labor website.  A fact sheet of the new requirements can be found at HealthCare.gov.

Comments are closed.

    Categories

    All
    External Links
    Health & Welfare Issues
    Horizon Updates
    News
    Pension Issues
    Publications

    Archives

    October 2022
    August 2022
    August 2021
    March 2021
    January 2021
    July 2020
    June 2020
    May 2020
    December 2019
    November 2019
    October 2019
    August 2019
    June 2019
    October 2018
    August 2018
    June 2018
    April 2018
    March 2018
    February 2018
    January 2018
    December 2017
    October 2017
    September 2017
    August 2017
    July 2017
    May 2017
    February 2017
    December 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    March 2016
    February 2016
    January 2016
    October 2015
    July 2015
    June 2015
    December 2014
    October 2014
    August 2014
    February 2014
    December 2013
    October 2013
    August 2013
    May 2013
    March 2013
    February 2013
    November 2012
    August 2012
    March 2012
    January 2012
    November 2011
    October 2011
    August 2011
    July 2011
    June 2011
    May 2011
    April 2011
    March 2011
    November 2010
    October 2010
    September 2010
    August 2010
    July 2010
    June 2010
    March 2010
    December 2009
    November 2009
    October 2009
    September 2009
    August 2009
    April 2009
    February 2008
    October 2007

    RSS Feed

Home | About Us | Our Services | Resources | Careers | Contact Us
Terms of Use | Website Privacy Policy | California Privacy Rights
​Copyright 2007-2021. Horizon Actuarial Services, LLC. All rights reserved.
​In Memory of Brian Dailey
  • Home
  • About Us
    • Horizon Updates
    • Selected Bios
  • Our Services
  • Resources
    • News
    • Publications
    • External Links
  • Careers
  • Contact Us