Friday, November 18, 2011

A Summary of Uniform Coverage (Part 3)

We’ve spent a lot of time talking about healthcare and the recent Summary of Benefits and Coverage (SBC) regulations, along with a few other topics, so perhaps it is time for a wrap up, and a few last explanations.

A few months ago, on the 17th of August, 2011, the Departments of Health and Human Services, Labor and Treasury issued proposed regulations for implementation of the Summary of Benefits and Coverage and the Uniform Glossary requirements under Section 2715 of the PPACA. These regulations were issued with the intention of providing every health plan provider and beneficiary with an accurate SBC in time for them to make effective decisions regarding their health plan enrollment.

Insurers are required to provide accurate, uniform SBC’s to all beneficiaries through the use of a provided template. The regulations also ensure that every insurer is provided with the tools, templates, and information required to meet the previously outlined requirements. Health plans are also required to be able provide a uniform glossary of terms and conditions, by request, within 7 days.

There are 12 main requirements outlined in the SBC regulations, including uniform definitions of standard insurance terms, description of the coverage, cost-sharing provisions of the coverage, coverage provisions, and a statement explaining that the provided SBC is only a summary of benefits and that the entire plan document should be consulted as well.

If they function as intended, these regulations should ensure that consumers are provided with the best possible information to make an informed decision about their healthcare. Health plans also stand to benefit from the regulations, as any outlined rules can help plans through the complex red tape of health compliance.

Merrill Corp supports the HHS regulations, and we are well-equipped to handle these new compliance requirements.


Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at

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