1 Vol. 77 Tuesday, No. 30 February 14, 2012. Part VII. Department of the Treasury Internal Revenue Service 26 Parts 54 and 602. Department of Labor Employee Benefits Security Administration 29 CFR Part 2590. Department of Health and Human Services 45 CFR Part 147. mstockstill on DSK4 VPTVN1 PROD with RULES4. Summary of Benefits and Coverage and Uniform Glossary; Final Rule VerDate Mar<15>2010 19:28 Feb 13, 2012 Jkt 226001 PO 00000 Frm 00001 Fmt 4717 Sfmt 4717 E:\FR\FM\ 14 FER4. 8668 Federal Register / Vol. 77, No. 30 / Tuesday, February 14, 2012 / Rules and Regulations DEPARTMENT OF THE TREASURY beneficiaries who enroll in group health This regulation establishes the plan coverage other than through an standards required to be met under PHS.
2 Internal Revenue Service open enrollment period (including Act section 2715. Among other things, individuals who are newly eligible for these standards ensure this information 26 CFR Parts 54 and 602 coverage and special enrollees), the is presented in clear language and in a [TD 9575] requirements under PHS Act section uniform format that helps consumers to 2715 and these final regulations apply better understand their coverage and RIN 1545 BJ94 beginning on the first day of the first better compare coverage options. The plan year that begins on or after current patchwork of non-uniform DEPARTMENT OF LABOR September 23, 2012. For disclosures to consumer disclosure requirements plans, and to individuals and makes shopping for coverage inefficient, Employee Benefits Security dependents in the individual market, difficult, and time-consuming, Administration these requirements are applicable to particularly in the individual and small health insurance issuers beginning on group market, but also in some large 29 CFR Part 2590 September 23, 2012.
3 Employer plans in which workers may RIN 1210 AB52 be confused about the value of their FOR FURTHER INFORMATION CONTACT: health benefits as part of their total Amy Turner or Heather Raeburn, compensation. As a result of this DEPARTMENT OF HEALTH AND. Employee Benefits Security confusion, health insurance issuers and HUMAN SERVICES. Administration, Department of Labor, at employers may face less pressure to [CMS 9982 F] (202) 693 8335; Karen Levin, Internal compete on price, benefits, and quality, Revenue Service, Department of the contributing to inefficiency in the health 45 CFR Part 147 Treasury, at (202) 622 6080; Jennifer insurance and labor markets.
4 RIN 0938 AQ73 Libster or Padma Shah, Centers for The statute is detailed but not self- Medicare & Medicaid Services, implementing, contains ambiguities, Summary of Benefits and Coverage Department of Health and Human and specifically requires the and Uniform Glossary Services, at (301) 492 4222. Departments to develop standards, AGENCIES: Internal Revenue Service, SUPPLEMENTARY INFORMATION: consult with the National Association of Department of the Treasury; Employee Customer Service Information: Insurance Commissioners, and issue Benefits Security Administration, Individuals interested in obtaining regulations. Therefore these consumer Department of Labor; Centers for protections cannot be established information from the Department of without this regulation.
5 Medicare & Medicaid Services, Labor concerning employment-based Department of Health and Human health coverage laws may call the EBSA 2. Legal Authority Services. Toll-Free Hotline at 1 866 444 EBSA The substantive authority for this ACTION: Final rule. (3272) or visit the Department of Labor's regulation is generally PHS Act section Web site ( ). In 2715, which is incorporated by SUMMARY: This document contains final addition, information from HHS on reference into Employee Retirement regulations regarding the summary of private health insurance for consumers Income Security Act (ERISA) section benefits and coverage and the uniform can be found on the Centers for 715 and the Internal Revenue Code glossary for group health plans and Medicare & Medicaid Services (CMS) (Code) section 9815.
6 PHS Act section health insurance coverage in the group Web site ( 2792, ERISA section 734, and Code and individual markets under the HealthInsReformforConsume/ section 9833 also provide rulemaking Patient Protection and Affordable Care ) and information on authority. (For a fuller discussion of the Act. This document implements the health reform can be found at http:// Departments' legal authority, see section disclosure requirements under section V. of this preamble.). 2715 of the Public Health Service Act to help plans and individuals better I. Executive Summary B. Summary of the Major Provisions of understand their health coverage, as A.
7 Purpose of the Regulatory Action This Regulatory Action well as other coverage options. A Paragraph (a) of the final regulations guidance document published 1. Need for Regulatory Action implements the general disclosure elsewhere in this issue of the Federal Under section 2715 of the Public requirement and sets forth the standards Register provides further guidance Health Service Act (PHS Act), as added for who provides an SBC, to whom, and regarding compliance. by the Patient Protection and Affordable when. The regulations outline three DATES: Effective date. These final Care Act (Affordable Care Act), the different scenarios under which an SBC.
8 Regulations are effective April 16, 2012. Departments of Health and Human will be provided: (1) By a group health Applicability date. The requirements Services, Labor, and the Treasury (the insurance issuer to a group health plan;. to provide an SBC, notice of Departments) are to develop standards (2) by a group health insurance issuer modification, and uniform glossary for use by group health plans and health and a group health plan to participants under PHS Act section 2715 and these insurance issuers offering group or and beneficiaries; and (3) by a health final regulations apply for disclosures to individual health insurance coverage in insurance issuer to individuals and participants and beneficiaries who compiling and providing a summary of dependents in the individual market.
9 Mstockstill on DSK4 VPTVN1 PROD with RULES4. enroll or re-enroll in group health benefits and coverage (SBC) that For each scenario, an SBC must be coverage through an open enrollment accurately describes the benefits and provided in several different period (including re-enrollees and late coverage under the applicable plan or circumstances, such as upon application enrollees) beginning on the first day of coverage.'' PHS Act section 2715 also for coverage, by the first day of coverage the first open enrollment period that calls for the development of standards (if information in the SBC has changed), begins on or after September 23, 2012.
10 For the definitions of terms used in upon renewal or reissuance, and upon For disclosures to participants and health insurance coverage.'' request. The final regulations also VerDate Mar<15>2010 19:28 Feb 13, 2012 Jkt 226001 PO 00000 Frm 00002 Fmt 4701 Sfmt 4700 E:\FR\FM\ 14 FER4. Federal Register / Vol. 77, No. 30 / Tuesday, February 14, 2012 / Rules and Regulations 8669. include special rules to prevent disclosures with respect to participants believe that the benefits of this unnecessary duplication in the and beneficiaries who enroll or re-enroll regulatory action justify the costs. provision of an SBC with respect to in group health coverage through an II.