Self-Insured Employers Must Provide Health Plan Benefits Summary Beginning Sept. 23

Employers who self-insure health care coverage must provide their participants with a standard summary of benefits and coverage, notice of modification, and uniform glossary for open enrollment periods beginning on or after September 23, 2012, as required under the Patient Protection and Affordable Care Act. Health insurance issuers must provide the SBC to beneficiaries in companies who purchase their plans.

The required content of the SBC includes: uniform definitions of standard insurance terms and medical terms so that consumers may compare health coverage and understand the terms of (or exceptions to) their coverage; a description of the coverage, including cost sharing-- deductible, coinsurance, and copayment obligations; the exceptions, reductions, and limitations on coverage; the renewability and continuation of coverage provisions; and a contact number to call with questions and an Internet web address where a copy of the actual individual coverage policy or group certificate of coverage can be reviewed and obtained. The U.S. Dept. of Labor’s Employee Benefits Security Administration has a fill-in-the-blank template that can be used, as well as FAQs Part VII; Part VIII; and Part IX on the required notification as well as other tools on their ADA webpage.