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Your Chance to Comment on New Proposed Health Care Regulations

The Departments of Health and Human Services, Labor and Treasury (the Departments) published a proposed rule under the Patient Protection and Affordable Care Act requiring group health plans covered under the Employee Retirement Income Security Act (ERISA) to provide a Summary of Benefits and Coverage (SBC) and a uniform glossary (glossary) to eligible participants.

The proposed rule is open for public comment until Oct. 21, 2011, so take advantage of the opportunity to participate in the process and provide input.  According to the Departments, the purpose of the SBC and glossary is to provide information in plain English to participants about their health coverage and allow them to easily compare different coverage options. 

Based on the proposed regulations, beginning March 23, 2012, group health plans must provide the SBC and glossary to eligible participants as part of any written application materials utilized with enrollment (or renewal) into the plan.  Plans must also provide the SBC when there is a material modification to the plan. Currently, the proposed regulations require the SBC and glossary in addition to the Summary Plan Description and Summary of Material Modifications, disclosures already required under ERISA. The Departments are soliciting comments on whether the new disclosures can be combined with the already existing requirements under ERISA. 

The proposed regulations also require that the SBC include coverage examples which illustrate benefits provided under the plan.  For example, a coverage example will walk a participant through each step of treatment, from a cost perspective, based on a particular diagnosis. The Departments may identify up to six coverage examples which will be required in the SBC; such as having a baby, treating breast cancer and managing diabetes. 

Comments are being solicited on the proposed coverage examples including the costs associated with developing the examples. Let the Departments know if you are concerned with the proposed disclosure requirements or have suggestions to help improve the requirements. It is your chance to be heard before the proposed regulations become effective.  The proposed template for the SBC can be viewed at:



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