Consumers and employers alike should have an easier time comparing options when shopping for health insurance coverage thanks to the final ruling issued by the U.S. Departments of Health and Human Services, Labor and the Treasury. The regulations apply to the Summary of Benefits and Coverage (SBC) and uniform glossary that, under the Affordable Care Act, must be given to all employees.
"The Administration is committed to improving the information consumers receive when shopping for health care coverage so they can make informed choices for themselves and their families," said Acting CMS Administrator Andy Slavitt. "These clarifications will also make it easier for issuers and group health plans to provide the most accurate health coverage information to consumers."
Though the final rules were issued in June, revisions to the uniform glossary and the SBC template are not expected to be finalized until January 2016, the Society for Human Resource Management reported. The revisions will apply to SBCs for coverage beginning on or after January 1, 2017. As part of the process, the departments plan to complete rigorous consumer testing and open feedback channels to solicit input from the public and industry groups, including the National Association of Insurance Commissioners.
Here are three key areas that HR professionals need to know from the new regulations:
1. Online access is a must
Issuers must provide a Web address to all individuals, plan sponsors and participants and beneficiaries shopping for coverage prior to submitting an application for coverage. At this Web address, people must be able to easily review and obtain a copy of the actual individual coverage policy or group certificate of coverage.
One important note: Because the certificate of coverage isn't available for the group market until after the plan sponsor negotiates the terms of coverage with the issuer, an issue for the group market only is allowed to satisfy this requirement by posting a sample plan certificate for the applicable product. But after the actual certificate of coverage is created, a Web address to this certificate must be made easily accessible to the plan sponsors, participants and beneficiaries.
2. Duplication will be limited
The final regulations aim to streamline how SBCs are distributed, eliminating the unnecessary duplication that stemmed from all parties tracking whether this info was provided properly. With the final regulations, it is clearer which party needs to distribute the SBC in three different situations:
• When a group health plan utilizes a binding contractual arrangement in which a separate party assumes responsibility to provide the SBC
• When a group health plan uses two or more insurance products provided by separate insurers for a single group health plan
• When the SBC for student health insurance coverage is provided by another party
3. Disclosures should be clear
As part of the ACA, issuers must notify consumers of any coverage that covers abortion services for which public funding is prohibited. The final ruling on the SBC makes it clear that this disclosure on the SBC should include whether non-excepted abortion services as well as excepted abortion services are covered or excluded. How this information is presented, though, is not set: It's expected that the departments future consumer testing and feedback between now and January 2016 will shape the wording and placement of this disclosure on the SBC. Until the new wording and design have been finalized, issuers for which this applies can adopt any "reasonable wording and placement of the disclosure on the SBC."