New Summary of Benefits and Coverage Template Posted

On Wednesday, the Department of Labor and the Centers for Medicare and Medicaid (CMS) posted the new and improved Summary of Benefits and Coverage form.  The SBC was designed to help employees compare benefit provisions and make educated decisions when shopping for a medical plan. However, employers provided feedback indicating confusion among SBC recipients.

The CMS press release explains “The SBC includes coverage examples that demonstrate the cost sharing amounts an individual might be responsible for in three common medical situations.  In addition to the current coverage examples that address diabetes care and childbirth, the updated template has a new coverage example that addresses coverage for a foot fracture so that a consumer understands what a plan covers in an emergency scenario.

Changes have also been made to the SBC to improve readability for consumers. The new templates include more information about cost sharing, such as enhanced language to explain deductibles and a requirement that plans address individual and overall out-of-pocket limits in the SBC.”

These enhancements, including hyperlinks to the definitions section in electronic versions, should make reading the SBC a bit easier come open enrollment time.

Most employers will begin to use this new template on the first day of the first open enrollment period that begins on or after April 1, 2017.

To access the existing SBC template, or to review the new one, visit the DOL website via the link below.