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New DOL Summary of Benefits and Coverage Template Goes Into Effect April 1

The U.S. Department of Labor (DOL) released a new template for the Summary of Benefits and Coverage (SBC) last year. As background, the Affordable Care Act requires health plans and health insurers to annually distribute SBCs to participants and enrollees. SBCs provide a general overview of covered benefits and cost-sharing, along with examples, in a format prescribed by the DOL. 

Health plans and health insurers will be required to use the new version beginning on the first day of the first open enrollment period that begins on or after April 1, with respect to coverage for plan years beginning on or after that date. For calendar-year plans, the new version must be used for the 2017 open enrollment period concerning January 1, 2018, coverage. The SBC format remains largely unchanged. The new SBC template contains some minor changes, including these notable modifications:

  • A third coverage example regarding a foot fracture treated in the emergency room

  • Revised language regarding minimum essential coverage, continuation coverage, and minimum value

  • A description of the embedded deductible for family coverage

  • Deleted content (e.g., questions and answers about the coverage examples), reducing the SBC from eight pages to five pages

  • An updated glossary

© 2020 Foley & Lardner LLPNational Law Review, Volume VII, Number 51


About this Author

Nicholas J. Engel, Foley, Employee Benefits Lawyer, Executive Compensation Law Graduate
Law Graduate

Nicholas (Nick) Engel is a law graduate with Foley & Lardner LLP. He is a member of the Employee Benefits & Executive Compensation Practice.

During law school, Mr. Engel worked as a student attorney for the Low Income Taxpayer Clinic, where he represented low-income taxpayers in audits, appeals, and collections disputes with the IRS. He also interned with the IRS Office of Chief Counsel in Milwaukee, assisting attorneys in preparing cases for trial in the U.S. Tax Court, as well as serving as a law clerk for a Milwaukee-based law firm....

Nick J. Welle, Foley, Employment Benefits Lawyer, qualified retirement plans attorney
Senior Counsel

Nick Welle is an associate and business lawyer with Foley & Lardner LLP. His practice is focused on health and welfare plans. He also assists clients with qualified retirement plans, including defined benefit and defined contribution plans.

Mr. Welle advises employers, insurers, and brokers concerning the federal laws governing health and welfare plans, including the Affordable Care Act (ACA), Employee Retirement Income Security Act (ERISA), Internal Revenue Code (Code), Health Information Portability and Accountability Act (HIPAA), Mental Health Parity and Addiction Equity Act (MHPAEA), Public Health Service Act (PHSA), Consolidated Omnibus Budget Reconciliation Act (COBRA), and the Family and Medical Leave Act (FMLA). He also assists clients with plan design and administration, including self-insured and fully-insured health and welfare plans and wellness programs. Mr. Welle has experience drafting and reviewing HIPAA policies and agreements, including privacy and security policies, business associate agreements, authorization forms, and notices of privacy practices.