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Updated Summary of Benefits and Coverage and Annual Limit Waivers

The agencies have released an updated Summary of Benefits and Coverage (SBC) template that plans will need to use for 2014. The updated template has very few changes from the version used for 2013.

The primary change is that the 2014 SBC must state whether or not the plan provides “minimum essential” and “minimum value” coverage. The template is designed to include the minimum essential and minimum value information on page 4 of the SBC.  If an employer or insurer has already begun preparing its 2014 SBC and including this information on page 4 would be difficult, the needed information can be included in an attachment or cover letter.

Beginning in 2014, plans may not have annual dollar limits on essential health benefits.  Plans may address this change by either:

  • Deleting the row that asks about annual limits; or
  • Completing the question with “no” and stating in the “Why It Matters” column: “The chart starting on page 2 describes any limits on what the plan will pay for specific covered services, such as office visits.”

There are no changes to the examples that must be completed in the SBC (including the stated cost of care), to the glossary that must accompany the SBC or to the SBC calculator.

Employers and carriers should continue to use the current version of the SBC template for any coverage that begins in 2013.

We have updated our Highlights and Frequently Asked Questions about the SBC; the updated pieces are HERE and HERE.  For additional information on minimum essential and minimum value coverage, go HERE.

Links to the revised SBC template, sample completed template and FAQ that was issued with the updated template are here:

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Annual Limit Waivers

The agencies have issued a FAQ that responds to questions about whether a change in plan or policy year would extend the waiver period for a plan that received a temporary waiver of the annual limit requirement.  (The waiver primarily affects mini-med plans.)  The FAQ states that the  plan or policy year in effect when the waiver was issued determines the date the waiver will expire.  The FAQ is here: [download id=”80″]