Summary of Benefits and Coverage
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.
More on Reform
READ REFORM TODAY
Insights, rules and views on how the Patient Protection and Affordable Care Act (PPACA) may impact you, businesses and the health care industry.
EMPLOYER MANDATE IN REFORM
Businesses must offer affordable medical insurance that provides “minimum value” to employees and their dependents.
INDIVIDUAL MANDATE IN REFORM
Under the health care reform law, all people must have minimum essential coverage beginning January 1, 2014.
ESSENTIAL HEALTH BENEFITS
These new standards are required for individual and small group plans and may also affect large group plans.