To help consumers compare the different features of health benefits and coverage, the Affordable Care Act requires all group health plans and health insurance companies to provide individuals a “summary of benefits and coverage” that “accurately describes the benefits and coverage under the plan.” The SBC is a snapshot of a health plan’s costs, benefits, covered healthcare services, and other features that are important to consumers. Along with the SBC, group health plans and health insurance companies must also provide a Uniform Glossary to explain common medical and insurance-related terms.
The Department of Labor (DOL) and the Department of Health and Human Services (HHS) have revised the Summary of Benefits and Coverage (SBC) template for plan years beginning on or after January 1, 2021. The following changes were made to the 2021 SBC template:
- Minimum Essential Coverage – Under the entry for minimum essential coverage, the SBC has been revised to reflect the elimination of the individual mandate penalty which was repealed effective January 1, 2019. The entry now indicates that individuals eligible for certain types of minimum essential coverage may not be eligible for a premium tax credit under the ACA Marketplace.
- Coverage Examples – Total costs under the examples for “Peg is having a baby”, “Managing Joe’s Type 2 diabetes”, and “Mia’s simple fracture” have been revised and updated. Please note, the coverage examples are standardized by HHS and cannot be altered.
- Uniform Glossary – The uniform glossary has been updated to remove references to the individual mandate penalty.
Diversified Group will keep you informed of any developments. Please feel free to contact your Diversified Sales Representative with any questions at (888) 322-2524.