Government Summary of Benefits and Coverage Typo Means New Templates

by Cathy Miller on May 15, 2012

in Health Care Reform, Health Insurance

 

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.

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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.

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