January 13, 2020

The Centers for Medicare and Medicaid Services and the Department of Labor issued updated templates, instructions, and related documents for the summary of benefits and coverage (SBC). Group health plans must begin distributing these updated versions for plan years beginning on or after January 1, 2021.

 

Under the ACA, group health plans and insurers are required to distribute SBCs to plan participants and applicants. Most group health plans fulfill this requirement by distributing SBCs and Uniform Glossaries during open enrollment and to mid-year new hires. For the most part, the new SBC template and Uniform Glossary are similar to the prior 2017 versions. A new crosswalk details revisions to the prior SBC calculator and coverage examples. Full details of the SBC requirements are available in the SBC regulations.

 

Next Steps

We recommend that plan sponsors:

• Review the new templates and instructions to determine what updates to SBCs are needed; and
• Work with third-party vendors to ensure that SBCs distributed during 2021 open enrollments and future years are consistent with the new templates and associated documents.

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Policy & Advocacy Compliance