DOL Issues Final Regulation on Summary of Benefits and Coverage, with Mandatory Form

February 10, 2012

Final regulations regarding the summary of benefits and coverage required by healthcare reform law were issued on February 9, 2012. The law requires all group health plans and insurers (including large group, self-funded, and grandfathered plans) to provide to all applicants and enrollees a uniform summary of benefits and coverage (“SBC”) and uniform glossary. The final regulations establish standards that are meant to ensure information is presented in clear language and in a uniform format that helps consumers to better understand their coverage and better compare coverage options. The new regulations supersede previously-issued proposed regulations and have revised the model template for the SBC, which all plans must use, such as by eliminating the requirement to specify premiums.

Under the final regulations, plan administrators and insurers will have until the first day of the first open enrollment period that begins on or after September 23, 2012 to provide the first SBCs. SBCs must also be provided for other enrollments (i.e., special enrollments, new hires) that occur starting the first day of plan year beginning on or after September 23, 2012.

Finally, if any material plan design changes alter the information contained in a previously issued SBC, a new SBC must be distributed well before the changes can become effective.

A copy of the final regulations is available at

To view the final template for the summary of benefits and coverage, visit

A Compliance Guide is available at

We will be reviewing and analyzing these extensive new regulations, so please contact a Cox Smith attorney for further guidance on how to comply with the new law.

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