Under the Affordable Care Act, health insurers and self-funded employers must provide a uniform Summary of Benefits and Coverage (SBC) to people who apply for and enroll in health plans. These plan documents must 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
- Standard glossary of medical and insurance terms
They must explain: when a new SBC must be provided, and how to access electronic versions
- Issuing responsibilities for plans including more than 1 insurer and 3rd party vendor
U.S.-issued expatriate plans are exempt from the requirement to provide SBCs.
There is a new SBC template for plan years beginning on or after January 1, 2021. The major change is the elimination of information about the penalty for not having Minimum Essential Coverage.