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Summary of Benefits Coverage and Uniform Glossary Requirements

Under a provision in the 2010 Patient Protection and Affordable Care Act (PPACA), health insurers and group health plans – including plans sponsored by employers – will be required to provide participants and beneficiaries with a Summary of Benefits Coverage (SBC) and a Uniform Glossary of common insurance terms. These new required communications are intended to give individuals clear, consistent, and comparable information about their health plans and benefits coverage.

Originally scheduled to take effect March 23, 2012, this provision’s implementation date was postponed until September 23, 2012 due to the volume of feedback government agencies received from plan sponsors and insurance companies.

What are the SBC and Uniform Glossary?

The SBC and Uniform Glossary are designed to aid employees in making better health care decisions. One of the key components of the SBC is the standardized plan comparison tool that helps employees easily see the main cost-sharing and coverage features of a given plan. The SBC information must be presented in a government-required template that is four pages (double-sided) and includes plan-specific information that describes the plan’s benefits and cost-sharing provisions, mainly in chart form. The goal of the template is to make it easy for an individual to compare his or her employer-provided plans to a spouse's employer-provided plans and individual plans.

The SBC’s plain language, in addition to a combination of chart information, plan-specific coverage scenarios, and a list of questions and answers, can empower individuals to be better health care consumers. Likewise, the Glossary’s approachable language and cartoon-like illustrations help make health care jargon easier for average workers to understand.

The SBC template, and other materials provided in the February 2012 final regulations can be found in the Resources section of the United States Department of Health and Human Services website.

How TriNet Will Help Clients

The final regulations published in February 2012 require that the SBC and Uniform Glossary must be provided to participants and beneficiaries:

  • before the first day of the first open enrollment period that begins on or after September 23, 2012 and,
  • to participants and beneficiaries that are newly eligible for coverage beginning on the first day of the first plan year that begins on or after September 23, 2012.   

Our medical insurance carriers and TriNet will manage the creation and review of the SBC and Uniform Glossary for all affected TriNet health plans. TriNet will post the SBCs on HR Passport, in compliance with electronic distribution requirements, and send the SBC by postal mail upon request.

Looking Ahead

During 2012 and 2013, TriNet and our insurance carriers will distribute the SBC and Uniform Glossary to worksite employees in accordance with the final regulations published in February 2012. In addition, TriNet is looking ahead to the new templates and instructions that will be published for use starting in 2014. This second iteration of templates will reflect other PPACA requirements, which TriNet is closely monitoring.
 
If you have questions related to the SBC or Uniform Glossary requirements or how TriNet will manage the creation and distribution of these disclosures, please email healthcarereform@trinet.com.