The Affordable Care Act (ACA) states that insurance payers, including both carriers as well as self-funded groups, must create SBC documents for their insureds. This mandate may pose a few questions to Third Party Administrators (TPAs) in the way they provide their service.
The time is ripe for health plans to strategize their options to meet the PPACA-required changes for Summaries of Benefits and Coverage (SBCs). In another six months, it will be mandatory for health plans to provide timely, tracked, uniform SBCs.
On November 17, 2011, the Departments of Health & Human Services, Labor, and the Treasury (the “Departments”) issued an FAQ document that addressed the concern of many health plans about being able to meet the proposed March 23, 2012 deadline for the summary of benefits and coverage (SBC) requirement that is part of the Patient Protection and Affordable Care Act (PPACA).
One area where many health plans can vastly improve their administrative efficiency is in the generation of health plan summaries of benefits and coverage (SBCs, or benefit summaries). These summaries are primarily member education and pre-enrollment documents that explain the benefits of plans with variable product options.