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
7108 Fairway Drive
Palm Beach Gardens, FL 33418
East Kennedy Boulevard
Tampa, FL 33602
Francisco, CA 94104
100 South 4th Street, Suite 550
St. Louis, MO 63102
June 25, 2015
Health and Welfare Law
Final Revised SBC Regulations
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
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.
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.
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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