- Changing of the term “person” to “individual.”
- A statement that copays may not be included in out-of-pocket limits.
- The removal of the definitions of copayments and coinsurance.
- Change of the “Limitations & Exceptions” column to “Limitations, Exceptions, & Other Important Information” which must now include:
- When the plan does not cover a certain service category, or a substantial portion of a service category.
- When cost sharing for covered in-network services does not factor into the out-of-pocket limit.
- Visit and/or dollar limits.
- When services require preauthorization.
- Note: cross-referencing is allowed if including all information in this section would cause the SBC to exceed four pages.
- New language about minimum essential coverage, minimum value, and language access services.
- The addition of a third Coverage Example about costs for a fracture, and slightly altered formatting to the Coverage Examples section.
- A statement regarding whether abortions are covered by the plan.
Benefits Think Preparing for 2018 open enrollment
Published
4 Min Read
Carl C. Lammers
Managing Associate
Lammers focuses his practice in counseling employers on the plan design, implementation, administration and compliance issues affecting all types of employee benefit plans, including but not limited … Read full bio
