Health Reform Summary of Benefits and Coverage Effective Date Delayed

On August 22, 2011, the U.S. Departments of Labor, Health and Human Services, and Treasury issued a proposed rule under the Patient Protection and Affordable Care Act that requires group health plans and health insurance issuers to: (1) provide a summary of benefits and coverage (“Summary”) to participants and beneficiaries, and (2) make available to participants and beneficiaries a uniform glossary of terms commonly used in health insurance coverage such as “deductible” and “copay.”  The Summary must include a description of the plan coverage, including cost sharing requirements, and any exceptions, reductions, and limitations of coverage.  The proposed rule includes a model Summary, which was developed for use by insurers in the individual market, that plans may modify as appropriate to meet this requirement.

 

The plan administrator for a self-insured plan and either the administrator or carrier for an insured plan must distribute the Summary at enrollment, annually, and upon request.  The proposed rule was initially effective beginning March 23, 2012.  However, on November 18, 2011, the DOL announced that the plan sponsors and insurers will not be required to comply with this requirement until final rules are issued and applicable.