Filed Under:Health Insurance, Individual Health

Labor extends benefits summary safe harbors

The Employee Benefits Security Administrations (EBSA) says the rules it applies to health plan summary of benefits and coverage (SBC) notices will be about the same in 2014 as they are this year.

EBSA, an arm of the U.S. Labor Department, has described the 2014 SBC rules in a new set of answers to frequently asked questions (FAQs) about the Patient Protection and Affordable Care Act of 2010 (PPACA).

Labor Department officials have developed the answers together with the U.S. Department of Health and Human Services (HHS) and the U.S. Treasury Department, the parent of the Internal Revenue Service, officials wrote in an introduction to the FAQ.

One PPACA provision requires health insurance issuers and health plans to give enrollees and potential enrollees standardized forms describing the benefits a plan offers. The SBC also must include scenarios showing how the plan would cover a common health event -- a pregnancy -- and a common chronic condition -- Type 2 diabetes.

EBSA will continue just about all rules, safe harbors and temporary relief that it's been offering this year, officials said.

The big change in 2014 will be that the creators of an SBC will have to state on the SBC whether the plan qualifies as being the kind of "minimum essential coverage" that can help an individual get out of having to pay the tax that PPACA will impose on people who fail to own a minimum amount of health coverage.

The SBC also must state whether the plan covers at least 60 percent of the allowed charges for covered services. Individual coverage and some other types of coverage must meet the minimum value standard to be classified as minimum essential coverage, officials said.

"Compliance assistance is a high priority for the departments," officials said. "Our approach to implementation is, and will continue to be, marked by an emphasis on assisting (rather than imposing penalties on) plans, issuers and others that are working diligently and in good faith to understand and come into compliance with the new law.” 

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