The Summary of Benefits and Coverage (SBC) is intended to provide a uniform format for describing health plan benefits, thereby allowing health insurance shoppers to make meaningful comparisons among available health plans, and to assist enrollees to better understand and use their own coverage. The uniform glossary of coverage and medical terms is to be used in tandem with the SBC to assist users in understanding terms used in the SBC. All health plans, including individual, small group, and large group; insured and self-insured; and grandfathered, transitional, and ACA compliant, are required to comply with the SBC requirements.

The SBC includes coverage examples that demonstrate the cost-sharing amounts that an individual might be responsible for in three common medical situations. In addition to the current coverage examples that address diabetes care and childbirth, the updated template has a new coverage example that addresses coverage for a foot fracture, so that a consumer understands what a plan covers in an emergency scenario.

The new SBC templates include more information about cost sharing, such as enhanced language to explain deductibles, and a requirement for plans to address individual and overall out-of-pocket limits in the SBC. The new SBC must be used for plan years with open enrollment periods beginning after April 1, 2017, and thus the SBC will not be used for marketplace plans for the 2017 coverage year.

What’s next? Plan sponsors should dedicate resources to updating SBCs for coverage beginning on or after January 1, 2017.