February 9, 2012, the Departments of Health and Human Services, Labor, and Treasury (the “Departments”) jointly released a final rule requiring health plans to provide consumers with clear, consistent and comparable summary information about benefits and coverage. The Departments developed such standards due to requirements in the Affordable Care Act.

Specifically, the new disclosure requirement sets forth standards for which insurers must provide a short, easy-to-understand Summary of Benefits and Coverage (the “SBC”), including a tool for comparing standardized plans and a uniform glossary of terms commonly used in health insurance coverage. The SBC must be provided in three scenarios:

1. By a group health insurance issuer to a group health plan;
2. By a group health insurance issuer and a group health plan to participants and beneficiaries; and
3. By a health insurance issuer to individuals and dependents in the individual market.

The SBC must include 12 content elements outlined in the final rule, including a description of coverage and cost sharing requirements such as deductibles, coinsurance, and co-payments as well as information regarding any exceptions, reductions, or limitations under the coverage. The SBC must also provide coverage examples for common benefits scenarios like childbirth and treatment for diabetes. In addition, insurers must present the SBC in a uniform format (i.e., a maximum of four pages with no print smaller than 12-point font).

The final rule requires plans issued after September 22, 2012 to provide consumers (including new, late, special and re-enrollees) with the SBC, glossary, and a notice of modification. More information on the final rule is available via HHS’ press release and fact sheet. Templates for the SBC and glossary are available here.