The Internal Revenue Service issued revised regulations regarding the Summary of Benefits and Coverage (SBC) that must be provided to those covered by health insurance plans. The SBC is intended to help individuals better understand their health coverage and to compare their plan with other coverage options.
For group insurance plans, such as employer-sponsored health insurance, the insurer provides the SBC to the employer for distribution to employees. In the individual insurance market, the insurer provides the SBC directly to the consumer.
The revised rules require the SBC to include a telephone number consumers can use if they have questions about a policy, and an internet address to obtain a copy of the policy or group certificate.
The regulations require insurers to provide an updated SBC if information in the document has changed between the time the application was submitted and when the insurance goes into effect. For group plans , the rules now require that participants must be given an SBC for each benefit package offered by the plan for which the participant is eligible.
A “safe harbor ” provision aimed at eliminating duplication allows plans that include products from more than one insurance company allows the plan administrator to issue a single complete SBC that includes all the relevant information.
A similar anti-duplication rule allows colleges and universities to provide a single SBC for the student health insurance coverage they offer.