Under health care reform, health insurers and self-funded employers must provide a uniform Summary of Benefits and Coverage to people who apply for and enroll in health plans.
The final rule of the Patient Protection and Affordable Care Act, which was issued on February 9, 2012 requires that plan documents include a:
- Four-page overview of plan benefits, cost sharing and limitations
- Required set of examples of how the plan works
- Phone number and internet address for obtaining copies of plan documents
A Standard glossary of medical and insurance terms must also be available.
The penalty for "willful" non-compliance is $1,000 for each plan enrollee.
We believe that it is in everyone's interest to ensure that plan participants understand the terms of their coverage. Accordingly, Cigna strongly supports the idea of making comprehensive and understandable coverage explanations available to plan participants.
We also see areas of the requirements that can be enhanced. As part of the regulatory process, we provided comments to HHS asking them to consider the recommendations summarized in our position paper (PDF).
- Read our Summary of Benefits and Coverage Fact Sheet
- Read our News Alert about the Final Rule
- Read our SBC FAQ
- Watch our webinar about the Summary of Benefits and Coverage