On March 11, 2016, the Departments of Labor (DOL), Health and Human Services (HHS), and Treasury (Departments) issued FAQ guidance addressing when plans and insurers must begin using the updated template for summaries of benefits and coverage (SBCs) and associated documents (see Practice Note, Summaries of Benefits and Coverage Under the ACA). In related guidance, HHS issued FAQs addressing the updated SBC template and state insurance regulation.

The updated SBC template is part of additional guidance from the Departments over the past year on SBCs. In June 2015, the Departments issued final regulations addressing SBC implementation and uniform glossary requirements for group health plans and insurers (see Legal Update, Final SBC Rules Apply Beginning in Fall 2015). On February 26, 2016, the Departments published an information collection request that proposed:

The public comment period for the updated template and related materials closes on March 28, 2016.

The FAQ issued by the Departments clarifies that after the close of the public comment period, the Departments will review the comments and "expeditiously" finalize the new SBC template and related documents. According to the Departments, the new SBC template and related documents will be required for use under a two-part implementation schedule keyed to whether the plan or coverage offers open enrollment.

For plans and insurers that use an annual open enrollment period, the SBC template and related documents must be used beginning on the first day of the first open enrollment period that begins on or after April 1, 2017 (for plan years that begin on or after April 1, 2017). For plans and insurers that do not use an annual open enrollment period, the SBC template and related documents must be used beginning on the first day of the first plan year beginning on or after April 1, 2017.

In the related FAQs, HHS indicated that insurers should defer to state regulators' instructions in determining which SBC template to include in filings with state regulators for the 2017 benefit year. In the individual market, state regulators should direct insurers to use the 2012 SBC template, because that is the authorized template for use in the individual market for the 2017 benefit year (see Legal Update, Final Summary of Benefits and Coverage Rules Include Six-Month Compliance Delay).

Among other changes, the updated SBC template includes revisions to the coverage examples and "Important Questions" section. Although plans and insurers will once again need to update their SBC templates and related documents after the government issues its final templates, the silver lining is that they will not have to scramble to have these documents in place for fall 2016 open enrollment.