HighRoads Comments on Federal Summary of Benefits and Coverage and Uniform Glossary Notice Draft Regulations

Leading Health Care Regulation Compliance Firm Sees Regulation Redundancies for Employers

BOSTON--(BUSINESS WIRE)-- HighRoads, the industry leader in employer health care compliance and benefits management, today offered its comments to draft regulations on the Summary of Benefits and Coverage (SBC) and the Uniform Glossary Notice of Proposed Rulemaking, published at 76 Fed. Reg. 52442 et. seq. (August 22, 2011). The proposed rule implements section 2715 of the Public Health Service Act (PHS Act) as added by section 1001 of the Patient Protection and Affordable Care Act (PPACA). These new regulations are expected to take effect March, 2012.

As a technology-enabled, health care regulation and ERISA communications firm for large- and medium-sized U.S. employers, HighRoads serves a large number of companies, many of which offer self-insured employee benefits plans. On behalf of these companies, HighRoads prepares Summary Plan Documents (SPDs) and Summary Material Modifications to communicate with the employers’ plan participants.

“For self-insured group health plans, there are a lot of unanswered questions in the proposed new regulations,” said Thomas Barker, former General Counsel of the U.S. Department of Health and Human Services (HHS), and partner in the law firm of Foley Hoag. Barker consults to HighRoads on regulatory matters. “As HighRoads’ formal comments state, the SBC’s are essentially redundant to current communication documents self-insured employers provide their employees. There is little positive gain but additional expense,” said Barker.

“That being said, with enactment of the new regulations only five months away, we encourage employers to start the process of becoming familiar with the SBC template in order to be in compliance. It is also prudent to meet with vendors and create a solid logistical plan for fulfilling distribution requirements. Employers should also take inventory to create a list of plans for which an SBC is required,” Barker said.

HighRoads has formally submitted the following comments:

Comments on the Summary of Benefits and Coverage (SBC)

“We agree that the proposed rule provides important protections to individuals who obtain health care coverage in the individual insurance marketplace. We also recognize that section 2715 of the PHS Act clearly applies to self-insured group health plans. We believe that the application of the statue to group health plans is redundant. It will cause additional burden for these plans, especially those who self-insure, with no real tangible benefit for the lives covered under the self-insured plan. Employers already engage in an annual enrollment communication campaign that is conducted before the start of the next plan year. Much of the information required in the SBC is already present in the annual enrollment communication material that employers provide to their employees. This is also true for the proposed requirement that an SBC accompany the enrollment material for each plan. This is typically already provided to employees by the employer during the enrollment period.”

Comments on the Uniform Glossary

“We find that the uniform glossary is meaningless for participants in a group health plan because it is not specific to plan provisions. There may be terms in the glossary that do not apply to a specific plan and thus may cause employees added confusion. Requiring the use of uniform glossary terminology also burdens group health plans and insurers with the task of changing printed material to match the uniform glossary terminology.”


“We are also concerned over the agencies’ statement of policy that state laws that are stricter than the proposed regulation are not subject to pre-emption. We urge the agencies to limit the ability of states to regulate employee benefit plans.”

To view the full comment letter visit http://www.highroads.com/docs/SBCcomment10_11.pdf

About HighRoads

The world’s leading employers choose HighRoads to gain complete control over their health care costs and compliance. With HighRoads’ service, employers have online access to benefits plan information and pricing, competitive benefits benchmarks, and complete benefits management. The privately-held company is headquartered in Woburn, MA. For more information, visit www.HighRoads.com.


HighRoads Company Contact:
Petra Marino, 781-503-4031
[email protected]
HighRoads Media Contact:
Erin Jones, 704-664-2170
[email protected]

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