No fines, penalties for payers' summary of benefits

Insurers won't be seeing fines or penalties if they don't comply with the health reform law's summary of benefits and coverage (SBC) requirements within the first year, federal officials said in a frequently asked questions document published Friday.

The FAQs, which the Departments of Health & Human Services, Labor and Treasury jointly released, acknowledged that insurers face administrative difficulties to provide the summaries, reported Bloomberg BNA. "During this first year of applicability, the departments will not impose penalties on plans and issuers that are working diligently and in good faith to comply," officials said.

The agencies also clarified that they won't take any enforcement actions related to expatriate plans and that insurers have until Sept. 23, 2013, to provide SBCs for products they don't actively market, reported LifeHealthPro.

In addition, the FAQs said insurers can provide an electronic SBC if enrollment or application is otherwise handled online, but they still must offer a paper copy as an alternative, according to the Health Affairs blog.

Other issues the agencies addressed in the FAQs include: Insurers must provide an SBC when members apply for coverage, but if negotiations occur, they don't have to issue another SBC until coverage actually begins. If insurers provide an SBC before members apply and the terms don't change upon application or enrollment, they don't have to issue another SBC. Insurers must provide an SBC when potential members request information related to coverage but not when members only inquire generally about coverage.

To learn more:
- see the summary of benefits and coverage FAQs
- read the LifeHealthPro article
- see the Health Affairs blog
- check out the Bloomberg BNA article

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