As of September 23, 2012, health insurers are required to produce a concise yet in-depth paper or electronic Summary of Benefits and Coverage (SBC) statement for each person interested in, requesting or modifying coverage. Many health insurers are racing against time to deploy a solution that will generate content to meet standards set forth by the Affordable Healthcare for America Act.
What is the Summary of Benefits and Coverage Mandate?
The mandate requires a template as well as financial calculation and wording guidelines that providers must deliver to consumers. Most health insurance providers already offer an “at a glance” type of summary; the mandate aims to unite the format across all health care insurers.
The eight-page document details coverage offered, such as a copay or coinsurance. It also specifies the typical costs for services as tabulated by the federal government, the monetary amount the insurer will cover, and what the insured member will owe if the policy does not fully cover a visit or procedure.
Avoid costly fines with a mandate-friendly solution
Without the solution, things can get expensive very quickly. The penalty is $1,000 per failure, which adds up fast because each person that needs the summary and does not get it according to the mandate is an individual $1,000 fine. An SBC must be produced yearly for existing members.
Unfortunately health care insurance providers do not always do everything the same way, which is why custom solutions are in demand. As the deadline looms, more solutions are being deployed to ensure companies comply with this important mandate.