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Health Care Reform: Guidance on Required Future Modifications to SBC, Other Issues


April 2013

The Internal Revenue Service (IRS), Department of Labor (DOL), and Department of Health and Human Services (HHS) issued new guidance on information which must be included in future Summaries of Benefits and Coverage (SBC) issued for health plans. For coverage years beginning on or after January 1, 2014, the SBC must include language regarding whether a plan or coverage provides minimum essential coverage and whether the plan’s share of total allowed costs meets minimum value requirements. Current SBCs issued in 2013 do not include (and are not required to include) this additional language. It is important to note that this is the only change made by the IRS, DOL, and HHS to the SBC template. Therefore, otherwise compliant SBCs will only require this minor revision for 2014. If a plan sponsor is unable to modify the SBC for 2014 in this manner, the Departments noted that the plan sponsor would be permitted to issue a cover letter or similar disclosure with the SBC which contains the required information on minimum essential coverage and minimum value.

The agencies also released an additional FAQ on various issues under the Affordable Care Act, including annual limit waivers, provider non-discrimination rules, coverage of approved clinical trials, and transparency in coverage reporting requirements. The agencies noted that they do not expect to issue regulations on coverage of clinical trials in the near future, and non-grandfathered group health plans (which must implement coverage of clinical trials in plan years beginning on or after January 1, 2014) may rely on a good faith, reasonable interpretation of the law. 

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