Heads up: Changes coming to the ACA’s Summary Statements

by Jared Bilski

The Summary of Benefits and Coverage (SBCs) statements that Obamacare requires employers to distribute to employees will look a little different next time around, thanks to new proposed changes by the feds.  

As HR pros know, the SBCs are statements that any employers offering healthcare coverage are required to distribute to eligible employees at open enrollment time. Generally, those statements are created by the health insurer.

Critics have consistently argued that, as structured, the SBCs are confusing and difficult to read, as well as lacking certain key info.

So the three main federal agencies charged with ACA implementation have set out to make some changes to the SBC templates as they currently stand.

A third cost-example

One of the SBC changes in the proposed final regs centers around specific cost examples. Currently, the SBCs provide examples for the typical costs associated with pregnancy and type 2 diabetes. Under the proposed final regs, the revised SBCs would also include a cost-example for a foot fracture, including specifics for ambulance services, emergency room care, X-rays, crutches and physical therapy.

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