Three Aspects to Consider in Meeting the SBC Applicability Date


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. Some plans may have developed in-house processes and systems that can support the generation of these summaries. But not every organization may have the required skillset or acumen to develop supportive systems in-house.

Every organization is different in terms of business processes, resource availability, risk tolerance, and infrastructure complexity. All options may not be viable for every company. I’d like to share three aspects that you may want to consider while deciding if an outside vendor would be a good choice with regards to meeting the SBC requirements for health plans.

  1. Familiarity with the regulation: Do you have internal subject matter experts who are familiar with the regulation? While some companies have devoted large task forces to working on understanding the regulation for months, others might have begun investigating fairly recently.  If you are in the latter camp, your resources will need to devote time to get familiar with the regulation, analyze what changes will be needed in your company, develop and implement a process and infrastructure to support necessary changes. If the task seems overwhelming, it might be a good idea to partner with people who have understood the approach to meet the PPACA-required SBCs rules and developed a packaged benefit summary solution that would bring a viable option to organizations facing the regulation.
  2. IT priorities: What are your IT organization’s commitments at the moment? Can they take on the responsibility of performing the work that will be needed? If not, you can outsource the work to an experienced vendor who has successfully implemented at other organizations. You’ll save time, effort and costs as well, as the speed of implementation would justify. However, if you have a strong IT bench with resources to spare, the in-house option could potentially be less costly.
  3. Infrastructure complexity: If you have a complex business process in place that demands integration between multiple systems such as claims or member portals, then I recommend going with a vendor who has not only the required subject matter expertise on SBCs but also proven experience in completing such complex integration implementations. The right mix of your IT and business users’ involvement along with the consulting service team will ensure both successful project execution and meeting the PPACA September deadline.

With change comes the opportunity for growth. I sincerely wish that these three areas of consideration help you channel your efforts in the right direction, so that PPACA-compliance changes bring growing value around the benefit summary generation process.


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