Government Summary of Benefits and Coverage Typo Means New Templates
Ah, typos – the great equalizer. It’s tough to come down on errors when your own template has a pretty big one.
As part of healthcare reform’s, Affordable Care Act, a Summary of Benefits and Coverage (SBC) is a requirement meant to make health coverage more understandable.
A few of the SBC requirements include:
- A summary of benefits
- A glossary of terms
- Examples of coverage for specified scenarios
It’s that last requirement that tripped up the U.S. Department of Labor, the U.S. Department of Health and Human Services and the U.S. Treasury Department (known collectively as the Departments).
In the Departments’ coverage example for diabetes, the human side was front and center when the original listed the allowed amount for insulin as $11.92 instead of $119.20.
Oops.
Updated Templates
The templates are another requirement for SBCs so it’s important to get this one right.
The Departments posted updated versions of the SBC template, the sample completed SBC, and the guide for coverage examples calculations for the diabetes scenario.
Look for the Corrected on May 11, 2012 (as shown in the image below). It’s only shown on Page 1 of each document.
More Answers
In addition to the corrected templates, the Departments issued responses to some Frequently Asked Questions about the implementation of SBCs.
Here are a few from the 14 answered.
- Issue of SBC – An issuer of health insurance is required to provide an SBC “as soon as practicable,” but no later than seven business days after the issuer receives a substantially complete application for health insurance
- Duplicate SBC - If an individual receives an SBC before applying for coverage, the health insurance issuer does NOT have to provide a duplicate SBC after the individual applies – IF there is no change in the required information
- Shopping for Coverage – Health insurance issuers ARE required to provide an SBC to group plans shopping for coverage IF the group plan asks for specific (rather than general) information
- Penalties - there will be NO penalties for non-compliance applied in the first year IF health insurance issuers and plans act in “good faith” to comply
The effective date is September 23, 2012, although compliance dates vary based on the type of insurance (e.g., group versus individual) and plan renewal dates.
==============================
Helping you Keep it simple, clear & uniquely yours – contact me for help with your business writing needs. Visit my business blog, Simply stated business.
===============================
Notice of Disclaimer –Cathy Miller is not an attorney or health care provider and cannot provide legal or health care advice. The information provided is for your general background only, and is not intended to constitute legal or health care advice as to your specific circumstances. We recommend you review legislation with legal counsel and visit your physician for health care issues.
Will Health Insurer Rebates Sizzle?
Do you feel a bit like the millions of Americans who play the lottery? Could you be one of the lucky consumers who receives a rebate on your health insurance?
According to The Kaiser Family Foundation, insurers will be coughing up $1.3 billion to consumers to comply with the Medical Loss Ratio (MLR) requirements of healthcare reform’s Affordable Care Act. Continue Reading »
Rolling the Dice on Employer-Sponsored Health Insurance
Even non-math wizards recognize funny numbers when we see them.
Since the passing of health reform’s Affordable Care Act (ACA), the estimates of U.S. employees losing employer-sponsored health insurance have been all over the board. Continue Reading »
Summary of Benefits Reprieve Brings Summer Heat for Employers
It was supposed to make things simple.
Health reform’s Affordable Care Act requires a Summary of Benefits and Coverage (SBC) that explains – in simple terms – the health benefits to plan participants. It also requires a uniform glossary of terms.
Some view the SBC as more pain than gain. Continue Reading »
Are Health Reform’s Essential Benefits Not So Essential?
It’s one of the provisions of the Affordable Care Act where everyone seemed to have an opinion.
What health care services deserve essential benefits status?
- There are 10 categories
- Individual/small group health plans in state Exchanges must offer them
- All Medicaid plans must offer them
- The provision is effective in 2014
The tricky part was what services should be included in those categories. HHS sought the opinion of the Institute of Medicine (IOM). Continue Reading »
Insurance Brokers At a Loss Over Medical Loss Ratio
It sounded like a good idea – require insurance companies to spend most of its premium dollars on health care and quality improvement.
Insurance brokers and agents are not feeling the love from the Medical Loss Ratio (MLR) provision of healthcare reform’s Affordable Care Act. Continue Reading »
Employer Health Coverage Report Says Don’t Play Taps Yet
Consulting firm, McKinsey & Co., created quite a summer breeze with a report it released in June.
According to the report, 45 to 50 percent of employers were definitely or probably going to pursue other alternatives to sponsoring health coverage – including dropping coverage.
This is all based on healthcare reform’s Affordable Care Act, and the provision that creates state insurance exchanges in 2014.
Enter another report that says Not so fast. Continue Reading »
CLASS Act Flunks Health Care Reform
Health care reform’s Community Living Assistance Services and Support program (CLASS Act) was supposed to be a national voluntary insurance program for long-term care.
It is now gone before it even started.
Government officials dismissed the CLASS Act from health care reform.
CLASS Act Curriculum
The CLASS Act was Senator Ted Kennedy’s baby and co-sponsored by New Jersey’s Representative Frank Pallone.
It was meant to act as a supplement (not a replacement) to private Long-Term Care (LTC) insurance or Medicaid.
From the start, there were problems with the provision. Continue Reading »
Health Reform: How Do You Define Essential Benefits?
Merriam-Webster defines essential as: of the utmost importance.
How would you apply that to health benefits?
That’s the request the federal government made to the Institute of Medicine (IOM) –
Help define the essential benefits package required by
health reform’s Affordable Care Act
Simple Benefit Summaries: Is That Possible?
For those of us who started in the business before the gods invented computers, understanding employee benefit summaries is easy. That’s not to say we like them.
Most consumers don’t either.
- Legalese peppers the forms for fear of lawsuits
- Medical terms only a doctor could love strangle comprehension
- And if a pink elephant’s crossing the street, forget about coverage
So, when you need simplicity, who do you call? The government. Continue Reading »
