Has transparency arrived? What the SBCs can mean for your benefits communication | Segal Benz

I’m all geeked out again. Yes, over regulations.

The Department of Labor, in partnership with Health and Human Services, has provided new information about the Summary of Benefits and Coverage (SBC) regulations, building upon the previously issued final regulations and guidelines for the SBCs. Specifically, they’ve provided:

1. A corrected SBC template
2. The behind-the-scenes inputs that will drive the maternity and diabetes cost calculations—so that all insurance carriers use the same assumptions when generating a rolled up cost for care
3. An email address to request Spanish, Chinese, and Tagalog versions of the documents

That calculator—the one that lets you truly compare apples to apples—that’s the gold mine. Unlike carrier estimator tools that are available today, the format of the SBC and the calculator driving it is the first time employees—heck, Americans—can easily see what a health event might cost under various cost-sharing plan designs. It’s a breakthrough, folks. Because other than us industry people, no one has any real idea how to compare health plans. And even if we point them to the cost calculator with our carrier, they won’t be able to compare our plan against a spouse’s plan. The assumptions could be the same but likely aren’t.

We’re one step closer to medical price transparency. Do you see that rainbow out your window?

Our recommendations

Okay, okay, I know there’s a lot of work that goes along with this. And we know most employers (including all of our clients) are already doing enough education about their own plans that this is a duplication—and not necessarily helpful additional effort. A few practical ideas as we dive headlong into enrollment season:

• Incorporate coverage examples in other places. If pregnancy and diabetes happen to be high-claim areas for you, you can get a lot of mileage from repeating these scenarios on your benefits website.
• Create a blog about the valuable information. Like them or not, the last thing we want is for employees to completely disregard the SBCs as another legally required document. How about a blog post that specifically suggests using the SBCs to compare all available options—those you offer and an employee’s spouse? Or an adult child’s coverage—perhaps through their university or on the individual market?
• Align your website glossary. While we don’t recommend completely replacing the existing wording about key terms on your benefits website name, make sure they are in synch. There may be some key inconsistencies with your plans. For example, you might not have co-payments in any of your plans.

If you’re waiting for the Supreme Court decision to implement anything related to the Affordable Care Act, the wait won’t be much longer.