Members of Congress Urge Administration to Adopt Strict Summary of Benefits and Coverage Regulation

Transparency, Quality and Cost Containment

Shortly after the Administration announced that it was pushing back the March 23, 2012, effective date of PPACA’s mandated four-page Summary of Benefits and Coverage (SBC) form, Senator John Rockefeller (D-WV) and Representative Rosa DeLauro (D-CT) sent a letter to the Administration arguing that there was “no excuse” for failing to meet the effective date and calling any delay “unacceptable.”  In contrast, the Administration’s move was welcomed by employers because, as the Association explained in our comments, the proposed March 2012 effective date was simply unrealistic given the significant administrative requirements imposed by the newly mandated SBC requirements and the fact that the regulations governing it have not been finalized.  In drafting final regulations, Rockefeller and DeLauro urged the Administration “to maintain the strongest possible consumer protections while implementing the [SBC] requirements” and “to reject any approach that exempts certain employers from the [SBC] requirements” explaining that they had “fought to expand consumer protections to every consumer, including those in large employer plans.”  The Association, however, had urged the Administration to provide a safe harbor for large employer plans so long as the information required under the SBC requirements is included in such plans’ summary plan descriptions because the information is “largely duplicative of information, which large group health plans are currently providing to participants and enrollees in a summary form.”  The two Members of Congress vigorously opposed any such alternative, arguing that “it is imperative that under all circumstances the [SBC] be treated as a stand-alone document.”  While it is very unlikely that the Administration would rescind its extension deadline to meet the SBC requirements, it is unclear whether it will adopt a strict approach in the regulations or a more flexible one, as advocated by the Association.  Final regulations are not expected until early next year.