Summary of Benefits and Coverage - Anthem Health Care Reform ...

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Distribution Mail, fax and email are viable distribution channels subject to various detailed requirements 1. Group Business (Small Group, Large Group, National Accounts) o Requests for medical information/application o Pre-enrollment for participants to compare during the selection process o Issuance of policy/certificate o Renewal/Material Modification 2. Individual (Under 65) o Shopping/Time of Application o Issuance of policy/certificate o Upon Request o Renewal/Material Modification Material Modification and 60-day Advance Notice applies to changes during a policy period – it does not apply to changes made at renewal. Final Rule Outcomes A review of the final regulation indicates that the agencies made only several min or changes. Below is a recap of the requirements in the final rule: Item Final Rule Compliance Date Individual coverage issued on or after September 23, 2012 Group coverage for open enrollments beginning on or after September 23, 2012 Culturally and Linguistically Appropriate Renewals The agencies will provide translations of the SBC template, sample language, and the Uniform Glossary in the languag es of Spanish, Tagalog, Chinese and Navajo. The agencies provided flexibility in that if the policy has not been issued or renewed prior to 30 days before the renewal date, the SBC must be provided as soon as practicable but no later than 7 business days after issuance of the new policy or receipt of written confirmation of intent to renew, whichever is earlier.
Insertion of premium figures in the SBC Glossary of Health Coverage and Medical Terms The agencies omitted the requirement for carriers to insert premium figures in the SBC. New Disclaimer added to indicate the terms used are not the same as their plan’s, and in the event of a conflict the plan language would govern Exclusion of the large group market The agencies have not excluded the large group market from the SBC requirements. Distribution rules for the group market indicate that the SBC can be combined with other materials (such as the Summary Plan Description) if the SBC is in the front of the document and contains all the required information Individual market, the SBC must be a stand-alone document Coverage Examples Notice of Material Modification The agencies rejected both positions Reduced the required coverage examples from 3 to 2, omitting the breast cancer example and retaining the maternity and Type 2 diabetes examples The agencies commented that for 2014 they will be adding more examples No substantive changes to this requirement Template Forms Insurers must use the template SBC forms developed by the NAIC The templates are for use in the first year - on or after 9/23/12 Agencies anticipate changing the templates for 2014 If plans do not neatly fit within the template, the instructions provide that insurers must use their best efforts to describe the plan consistent with the template format
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Summary of Benefits and Coverage - Anthem Health Care Reform ...

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