TPAs Address Challenges in Approaching ACA-Mandated Uniform Summaries of Benefits and Coverage


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.

  1. Is it my responsibility to create the SBCs or the insurers’?
  2. Are my customers, especially self-funded, expecting me to take this on? If yes, how should I approach?
  3. I want to play a role in assisting my customers with this. Should I provide this service gratis or add this service at a fee?

These are the most common concerns voiced by the TPAs I’ve consulted with.   However, while the concerns remain common, the varying approaches to the questions vary as much as the individual business themselves.

Some TPAs believe that they can offer SBC creation as a paid service to their customers, who may have to choose whether or not to participate in the program. This could be a new revenue model for the TPAs, but they risk displeasing their existing customers who expect to get the service for free. Customers who opt out are left to their own methods to create SBCs, which leaves a significant service gap between the customer and the TPA.

Smaller TPAs may feel that they can make do using programs such as Microsoft Word to create the documents. This option is low in costs, and could serve for a small enough number of self-funded groups, say fewer than 100. But keeping this manual process alive with dedicated resources is not desirable. A mistake here and there in the process is inevitable when dealing with minute details, need including accurate versioning of documents. Just imagine the plight as the number customers starts multiplying or when performing administration for a carrier.

Outdated versions, manually-intensive production, and the potential for mistakes that can come from creating thousands of documents are just too risky to approach using a non-automated system. The right system should be highly specialized and straightforward to utilize, and come with a high level of service to assist in implementation. It should be flexible enough to accommodate future changes and ably built to store and organize thousands of client plans.

The VUE Benefit Summary Tool has proven to a number of TPAs to be a good fit solution. You can contact me (954-419-1008 x 2301) to learn more about how you can meet your client’s goals in creating compliant SBC documents.


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