Health Care Reform Update - DOL Announces Delay Affecting SBC Final Rules and Template

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Willis Human Capital Practice, National Legal & Research Group
On March 30, 2015, the U.S. Department of Labor (DOL) Employee Benefits Security
Administration (EBSA) issued another FAQ (Part XXIV) about the implementation of the health
care reform law. This FAQ provides an update on when the agencies expect to finalize proposed
rules on the summary of benefits and coverage (SBC) and uniform glossary that were issued by
the Departments of Labor, Treasury and Health and Human Services (the “Departments”) on
December 22, 2014. The proposed changes were to be effective for plan years beginning on or
after September 1, 2015.
According to the FAQ, finalized regulations “are intended to apply in connection with 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, 2016 (including open season periods that occur in
the Fall of 2015 for coverage beginning on or after January 1, 2016).”
Further, “[t]he Departments anticipate the new template and associated documents will be
finalized by 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 open season periods that occur in the Fall of 2016 for coverage beginning on or
after January 1, 2017)."
Background
The health care reform law expanded health plans’ disclosure obligations, requiring distribution
of a uniform four-page “summary of benefits and coverage” – an SBC. Any employer-sponsored
plan – whether insured or self-insured – that provides, pays for or reimburses the cost of health
care is a “group health plan” that may be subject to the SBC requirement. And any type of
employer (e.g., religious, governmental, for-profit and not-for-profit) may maintain a group
health plan that is potentially subject to the SBC requirement. To the extent that a plan consists
of “excepted benefits,” such as stand-alone dental and vision benefits, the plan is exempt from
the SBC requirement.
WEEK OF MARCH 30, 2015:
Health Care Reform Update - DOL Announces Delay Affecting
SBC Final Rules and Template

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Health Care Reform Update | Willis Human Capital Practice, National Legal & Research Group
Proposed Regulations
The proposed regulations amend the final regulations published on February 14, 2012 and
include revisions to the SBC templates, instruction guides, uniform glossary, and other
supporting materials.
Highlights of the proposed changes, which are intended to make the SBC more user-friendly,
include:
• Format changes that shorten the length of the sample completed SBC template from four
double-sided pages to two-and-a-half double-sided pages.
• The addition of a third cost of coverage example involving a simple foot fracture with
emergency room visit (the current coverage examples are having a baby and managing
type 2 diabetes).
• Revision of a few of the existing definitions in the uniform glossary as well as the
addition of new definitions reflecting important insurance or medical concepts (such as
“claim,” “screening,” “referral,” and “specialty drug”), as well as key terms that are
relevant in the context of the health care reform law (such as “individual responsibility
requirement,” “minimum value,” and “cost-sharing reductions”).
The amended SBC template, uniform glossary and other related materials are available for
review at http://cciio.cms.gov and www.dol.gov/ebsa/healthreform.
This information is not intended to represent legal or tax advice and has been prepared solely for informational
purposes. You may wish to consult your attorney or tax adviser regarding issues raised in this publication.