Section 2715: Summary of Benefits and Coverage (SBC)

What follows is my summary of key points from an article on the Health Affairs Blog. You can find the full length article here: Implementing Health Reform.

– Eric

In early February, the DOH issued a final version of section 2715 of the Public Health Services Act. This section deals with group health plans and the requirements for providers to issue “summary of benefits and coverage (SBC)” before applying restrictions to coverage.

The Significance Of Section 2715

  • the SBC will provide a ready reference for consumers who are comparison shopping for insurance
  • the SBC will assist consumers in identifying the plan that best suits their particular health care needs,
  • the SBC will provide a ready reference point for enrollees once they actually begin using their insurance coverage

What the SBC must include

  • a description of coverage and cost-sharing for each of the essential benefits listed in the ACA
  • a coverage facts label that includes examples to illustrate common benefits scenarios

Health plans that willfully fail to provide the SBC as required by the statue are subject to a fine of up to $1000 for each enrollee to which they fail to provide the form.

The new rule goes into effect in 6 months – officially on September 23, 2012.

About thebenefitblog

Eric is a Producer at Lockton Insurance Brokers, Inc., the world’s largest privately held commercial broker. Eric has over 23 years of experience in the insurance industry and has spent the last 11 years with Lockton. Eric specializes in Health & Welfare Benefits, Retirement Planning, and Executive Benefits. Eric's clients utilize his expertise in the areas of Plan Due Diligence, Transaction Structure, Fiduciary Oversight, Investment Design, Compliance and Vendor negotiation to improve the operational & financial outcome for each client. The Benefit Blog is a place to share that expertise and industry news.
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