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The Wagner Law Group

The Wagner Law Group, A Professional Corporation, is a nationally recognized ERISA & employee benefits, estate planning, employment, labor & human resources practice. 

 

Established in 1996, The Wagner Law Group has 22 attorneys engaged exclusively in employee benefits, estate planning and employment law. Six of our attorneys are AV rated by Martindale-Hubbell as having very high to preeminent legal abilities and ethical standards. The firm is among the largest ERISA boutiques in the country. Our practice is national in scope, with clients in more than 40 states and several foreign countries.

 

 

 

 

Contact Info

The Wagner Law Group

 

  Integrity | Excellence

  

Boston 

Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110


Palm Beach Gardens 

Tel: (561) 293-3590
Fax: (561) 293-3591
7108 Fairway Drive
Suite 125
Palm Beach Gardens, FL 33418

   

Tampa

Tel: (813) 603-2959

Fax: (813) 603-2961

101 East Kennedy Boulevard

Suite 2140
Tampa, FL  33602 

 

San Francisco

Tel: (415) 625-0002

Fax: (415) 358-8300

300 Montgomery Street

Suite 600

San Francisco, CA 94104

 

St. Louis

Tel: (314) 236-0065

Fax: (314) 236-5743
100 South 4th Street, Suite 550
St. Louis, MO  63102 

 

www.wagnerlawgroup.com

 

 

 

 

March 3, 2016

 

 Health and Welfare Law Alert

 

 

 

Agencies Propose Revised SBC Template

 

 

 

DOL, HHS and IRS have jointly proposed a revised Summary of Benefits and Coverage ("SBC") template and related materials.  The revised SBC will likely become effective for plan years beginning with the second quarter of 2017.

 

 

Background.  Under the Affordable Care Act, both insured and self-funded group health plans (including grandfathered plans) must provide a uniform explanation of benefits and coverage to plan participants and beneficiaries, and other individuals eligible to enroll in the plan. 

 

 

An SBC is also required for individual insurance contracts.  Insurers who provide coverage to group health plans are also required to provide SBCs to the plan itself.  However, individuals need only receive one SBC, from either the insurer or the group health plan.

 

 

SBCs must contain standardized information in a uniform format to help individuals understand the key features of a plan and make more informed decisions when selecting coverage. 

 

 

Revised SBC Template.  The proposed SBC template, which consists of 2½ double-sided pages of prescribed content, is shorter than the current SBC template.  Revisions made in the proposed SBC template include:

 

  • Revised "Important Questions" Section.  The proposed SBC template adds new questions about deductibles, out-of-pocket limits and network providers, and eliminates certain questions regarding annual limits (which are no longer permitted) and non-covered services (which are addressed elsewhere in the SBC template). 
  • Revised Disclosures.  The proposed SBC template includes the following new disclosures: whether the plan provides minimum essential coverage; if the plan meets minimum value requirements; an explanation of exemptions and premium tax credits; and required specific language to address potential tax consequences (i.e., the individual mandate penalty).  Disclosures about continuation coverage and grievance and appeal rights have been revised, with additional language being based on certain factors such as whether the plan is covered by ERISA.
  • New Coverage Examples.  The proposed SBC adds a third coverage example (involving a simple fracture), provides clearer information about the plan's deductibles and coinsurance, and eliminates hypothetical costs for specific services (e.g., lab tests and prescriptions) under each scenario.
  • New Instructions.  The instructions for completing the SBC include new information on addressing coverage or exclusion of abortion services, and incorporate previously-issued guidance on combining information for different cost-sharing options and explaining the effect of a health FSA, HRA, HSA or wellness program.
  • Uniform Glossary.  Proposed revisions include the requirement that SBCs underline terms defined in the glossary and, in electronic SBCs, hyperlink directly to the definition.

 

Takeaway for Employers.  While the proposed revised SBC is a marked improvement over the current SBC, employees will likely have to wait until the 2018 open enrollment period for these changes to take effect.

 

 

 

The proposed SBC is available at:  http://www.dol.gov/ebsa/pdf/sbc-template-proposed-new.pdf

 

 

 

 

 

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This Newsletter is provided for information purposes by The Wagner Law Group to clients and others who may be interested in the subject matter, and may not be relied upon as specific legal advice.  This material is not to be construed as legal advice or legal opinions on specific facts. Under the Rules of the Supreme Judicial Court of Massachusetts, this material may be considered advertising.