Heads up: Changes coming to the ACA’s Summary Statements
The Summary of Benefits and Coverage (SBCs) statements that Obamacare requires employers to distribute to employees will look a little different next time around, thanks to new proposed changes by the feds.
As HR pros know, the SBCs are statements that any employers offering healthcare coverage are required to distribute to eligible employees at open enrollment time. Generally, those statements are created by the health insurer.
Critics have consistently argued that, as structured, the SBCs are confusing and difficult to read, as well as lacking certain key info.
So the three main federal agencies charged with ACA implementation have set out to make some changes to the SBC templates as they currently stand.
A third cost-example
One of the SBC changes in the proposed final regs centers around specific cost examples. Currently, the SBCs provide examples for the typical costs associated with pregnancy and type 2 diabetes. Under the proposed final regs, the revised SBCs would also include a cost-example for a foot fracture, including specifics for ambulance services, emergency room care, X-rays, crutches and physical therapy.
This isn’t the first mention of the foot-fracture example. Back in 2014, the Centers for Medicare & Medicaid Services (CMS) proposed an SBC that illustrated the cost of “a simple fracture.”
But now the feds have personalized the examples in the latest revised SBC template by adding individuals’ names to the corresponding conditions. In the new version of the SBC, the examples are listed as:
- “Peg’s baby,”
- “Mia’s simple fracture,” and
- “Joe’s diabetes.”
Other template tweaks
In addition to the personalized cost-estimate example, the revised SBC template offers some other changes.
There’s a list of answers to “important questions,” such as:
- Does the plan have an overall deductible? and
- Does the plan has other deductibles for specific services?
The latest version of the SBC would also answer require provider to answer the following question for plan participants: Are there services covered before you meet your deductible?
The feds also updated the SBC glossary to add complicated ACA-related terms like “cost-sharing reduction,” and basic terms like “claim.”
