The Wagner Law Group
Wagner Law Group, A Professional Corporation, is a nationally
recognized ERISA & employee benefits, estate planning,
employment, labor & human resources practice.
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.
Wagner Law Group
Fax: (561) 293-3591
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Tampa, FL 33602
Francisco, CA 94104
100 South 4th Street, Suite 550
St. Louis, MO 63102
March 3, 2016
Health and Welfare Law
Agencies Propose Revised SBC
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.
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.
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.
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:
"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
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.
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.
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
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
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