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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

315 Montgomery Street

Suite 904

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

 

 

 

 

June 25, 2015

 

 Health and Welfare Law Alert

 

 

 

Final Revised SBC Regulations Issued

 

 

 

 

IRS and the Departments of Labor and Health and Human Services have issued final revised regulations that identify the standards for the Summary of Benefits and Coverage ("SBC") requirement under the Patient Protection and Affordable Care Act ("ACA"). 

 

Under the ACA, 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.

 

Under the new regulations: 

  • The anti-duplication rules have been expanded. In particular, the regulations explain that a plan administrator may contract to require another entity to provide the SBC.
  • The requirements for electronic distribution of SBCs are clarified.
  • The SBC must state whether the plan offers minimum essential coverage and meets the minimum value requirement.
  • The requirements for the SBC when the terms of coverage are not yet finalized are explained. 

The new regulations are effective on the first day of the first plan year that begins on or after September 1, 2015. For disclosures to plans, the 2015 final regulations apply to health insurers beginning September 1, 2015.

 

Although the proposed regulations included a draft of a new SBC template, the agencies now say that the new SBC template and associated documents will not be finalized until January 2016, and will apply to coverage that would renew or begin on the first day of the first plan year (or, in the individual market, policy year) that begins on or after January 1, 2017 (including coverage beginning on or after January 1, 2017, for which open enrollment occurs in the fall of 2016). Until the new template is issued, both insurers and group health plans may rely on prior guidance. Therefore, among other things, the statement regarding the offer of minimum essential coverage and minimum value will not be required until the new templates are issued.

 

 

 

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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.