ERISA-DOL Discusses Templates To Be Used For Summary of Benefits And Coverage

The U.S. Department of Labor (the “DOL”) has issued FAQs about Affordable Care Act Implementation (Part XIX), which provide guidance on the templates that should be used for a plan’s Summary of Benefits and Coverage under the Affordable Care Act (the “ACA”). Here is what the FAQs say:

In general. PHS Act section 2715, as added by the ACA and incorporated by reference into ERISA and the Code, directs the governing Departments (DOL, Treasury and Health and Human Services) to develop standards for use by a group health plan in compiling and providing a summary of benefits and coverage (an “SBC”) that accurately describes the benefits and coverage under the applicable plan. On February 14, 2012, the Departments published final regulations regarding the SBC. At the same time, the Departments published a notice announcing the availability of templates, instructions, and related materials authorized for implementing the disclosure provisions under PHS Act section 2715 for the first year of applicability (that is, for SBCs and the uniform glossary provided with respect to coverage beginning before January 1, 2014).

The Departments stated that updated materials would be issued for later years. The Departments issued FAQs in April 2013 providing guidance for SBCs provided with respect to coverage beginning on or after January 1, 2014, and before January 1, 2015 (“the second year of applicability”).

The Templates. An updated SBC template (and sample completed SBC) were made available at http://cciio.cms.gov and http://www.dol.gov/ebsa/healthreform in April 2013 for the second year of applicability. Until further guidance is issued, these documents continue to be authorized. There are no changes to the uniform glossary or the “Why This Matters” language for the SBC. There are also no changes to the Instructions for Completing the SBC, including the special rule providing that, “[t]o the extent a plan’s terms that are required to be described in the SBC template cannot reasonably be described in a manner consistent with the template and instructions, the plan or issuer must accurately describe the relevant plan terms while using its best efforts to do so in a manner that is still as consistent with the instructions and template format as reasonably possible.”

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