Michelle Capezza Interviewed in “SBC Changes: What Employers Need to Know”

Employee Benefit News

Michelle Capezza, a Member of Epstein Becker Green in the Employee Benefits and Health Care and Life Sciences practices, in the firm’s New York office, was interviewed in Employee Benefit News, in “SBC Changes: What Employers Need to Know,” by Andrea Davis.

Following is an excerpt:

Under the proposal, the Departments are suggesting shortening the SBC template to two-and-a-half double-sided pages, from four. So hopefully that will be a little less cumbersome and straight to the point.

You can also delete references to annual limits for essential benefits and pre-existing conditions because, with the health reform law, those are no longer applicable.

The SBC also has to have a statement whether the coverage is minimum essential coverage and provides minimum value. Before, it was an optional statement.

There’s also a new coverage example. In addition to the current examples of a routine birth and delivery and management of type 2 diabetes, the SBC would have to include an emergency room visit for a simple foot fracture.

The coverage example calculator, which was only available during certain transition times, is now going to be allowed for continued use. It will be updated and authorized for continued use.

The uniform glossary is expanded to six pages from four. And there will be some new definitions for claims, screening, referrals, specialty drugs, individual responsibility requirement, minimum value and cost-sharing reductions. It’s giving a little more information to help the health plan consumer and participant understand the terminology.