Publications & White Papers

Feature Article on End State Renal Disease by Jakki Lynch (reprinted from The Self-Insurer magazine).

Update on Hospital Variation in Nitric Oxide Use for Premature Infants

PPACA Regulatory Update

Agency Releases Final Rule for Standards for Mandated Summaries of Benefits and Coverage for Group Health Plans

The Department of Labor has just issued Final Rules on the PPACA mandate that sponsors of group health plans provide to eligible enrollees a summary of benefits and coverage scenarios of the plan. The summary must be brief and written in easy to understand language. Sponsors of plans are also required to provide a glossary of commonly used insurance terms.

The Final Rule requires plans sponsors to provide the summary and glossary at each new plan year, and within seven business days of requesting a copy from their health insurance issuer or group health plan.

The summary must also include coverage examples which will "illustrate how a health insurance policy or plan would cover care for common benefits scenarios. Using clear standards and guidelines provided by the Center for Consumer Information and Insurance Oversight (CCIIO), plans and issuers will simulate claims processing for each scenario so consumers can see an illustration of the coverage they get for their premium dollar under a plan."

Sponsors of plans will be required to provide the summaries and glossary for plan years beginning on or after 9/23/12.

The following are helpful links that can be used for complying with this mandate:

• Compliance Guide
• Summary of Benefits and Coverage Template
• Sample Completed SBC
• Instructions for Completing the SBC - Group Health Plan Coverage
• Instructions for Completing the SBC - Individual Health Insurance Coverage
• Why This Matters language for "Yes" Answers
• Why This Matters language for "No" Answers
• HHS Information for Simulating Coverage Examples
• Uniform Glossary of Coverage and Medical Terms