[Federal Register Volume 76, Number 162 (Monday, August 22, 2011)]
[Proposed Rules]
[Pages 52475-52531]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-21192]


-----------------------------------------------------------------------

DEPARTMENT OF THE TREASURY

Internal Revenue Service

26 CFR Part 54

DEPARTMENT OF LABOR

Employee Benefits Security Administration

29 CFR Part 2590

DEPARTMENT OF HEALTH AND HUMAN SERVICES

[CMS-9982-NC]

45 CFR Part 147


Summary of Benefits and Coverage and Uniform Glossary--Templates, 
Instructions, and Related Materials Under the Public Health Service Act

AGENCY: Internal Revenue Service, Department of the Treasury; Employee 
Benefits Security Administration, Department of Labor; Centers for 
Medicare & Medicaid Services, Department of Health and Human Services.

ACTION: Solicitation of comments.

-----------------------------------------------------------------------

SUMMARY: The Departments of the Health and Human Services, Labor, and 
the Treasury (the Departments) are simultaneously publishing in the 
Federal Register this document and proposed regulations (2011 proposed 
regulations) under the Patient Protection and Affordable Care Act to 
implement the disclosure for group health plans and health insurance 
issuers of the summary of benefits and coverage (SBC) and the uniform 
glossary. This document proposes a template for an SBC; instructions, 
sample language, and a guide for coverage examples calculations to be 
used in completing the template; and a uniform glossary that would 
satisfy the disclosure requirements under section 2715 of the Public 
Health Service (PHS) Act. Comments are invited on these materials.

DATES: Comment Dates: Comments are due on or before October 21, 2011.

ADDRESSES: Written comments may be submitted to any of the addresses 
specified below. Any comment that is submitted to any Department will 
be shared with the other Departments. Please do not submit duplicates.
    All comments will be made available to the public. Warning: Do not 
include any personally identifiable information (such as name, address, 
or other contact information) or confidential business information that 
you do not want publicly disclosed. All comments are posted on the 
Internet exactly as received, and can be retrieved by most Internet 
search engines. No deletions, modifications, or redactions will be made 
to the comments received, as they are public records. Comments may be 
submitted anonymously.
    Department of Labor. Comments to the Department of Labor, 
identified by RIN 1210-AB52, by one of the following methods:
    <bullet> Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the instructions for submitting comments.
    <bullet> E-mail: <a href="/cdn-cgi/l/email-protection#13563e5c5b43405052212422263d5651405253777c7f3d747c65"><span class="__cf_email__" data-cfemail="13563e5c5b43405052212422263d5651405253777c7f3d747c65">[email protected]</span></a>.
    <bullet> Mail or Hand Delivery: Office of Health Plan Standards and 
Compliance Assistance, Employee Benefits Security Administration, Room 
N-5653, U.S. Department of Labor, 200 Constitution Avenue NW., 
Washington, DC 20210, Attention: RIN 1210-AB52.
    Comments received by the Department of Labor will be posted

[[Page 52476]]

without change to http://www.regulations.gov and http://www.dol.gov/ebsa, and available for public inspection at the Public Disclosure 
Room, N-1513, Employee Benefits Security Administration, 200 
Constitution Avenue, NW., Washington, DC 20210.
    Department of Health and Human Services. In commenting, please 
refer to file code CMS-9982-NC. Because of staff and resource 
limitations, we cannot accept comments by facsimile (FAX) transmission.
    You may submit comments in one of four ways (please choose only one 
of the ways listed):
    1. Electronically. You may submit electronic comments on this 
regulation to http://www.regulations.gov. Follow the instructions under 
the ``More Search Options'' tab.
    2. By regular mail. You may mail written comments to the following 
address ONLY: Centers for Medicare & Medicaid Services, Department of 
Health and Human Services, Attention: CMS-9982-NC, P.O. Box 8016, 
Baltimore, MD 21244-1850.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    3. By express or overnight mail. You may send written comments to 
the following address ONLY: Centers for Medicare & Medicaid Services, 
Department of Health and Human Services, Attention: CMS-9982-NC, Mail 
Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    4. By hand or courier. If you prefer, you may deliver (by hand or 
courier) your written comments before the close of the comment period 
to either of the following addresses:
    a. For delivery in Washington, DC--Centers for Medicare & Medicaid 
Services, Department of Health and Human Services, Room 445-G, Hubert 
H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 
20201.
    (Because access to the interior of the Hubert H. Humphrey Building 
is not readily available to persons without Federal government 
identification, commenters are encouraged to leave their comments in 
the CMS drop slots located in the main lobby of the building. A stamp-
in clock is available for persons wishing to retain a proof of filing 
by stamping in and retaining an extra copy of the comments being 
filed.)
    b. For delivery in Baltimore, MD--Centers for Medicare & Medicaid 
Services, Department of Health and Human Services, 7500 Security 
Boulevard, Baltimore, MD 21244-1850.
    If you intend to deliver your comments to the Baltimore address, 
please call (410) 786-9994 in advance to schedule your arrival with one 
of our staff members.
    Comments mailed to the addresses indicated as appropriate for hand 
or courier delivery may be delayed and received after the comment 
period.
    Submission of comments on paperwork requirements. You may submit 
comments on this document's paperwork requirements by following the 
instructions at the end of the ``Collection of Information 
Requirements'' section in this document.
    Inspection of Public Comments: All comments received before the 
close of the comment period are available for viewing by the public, 
including any personally identifiable or confidential business 
information that is included in a comment. We post all comments 
received before the close of the comment period on the following Web 
site as soon as possible after they have been received: http://www.regulations.gov. Follow the search instructions on that Web site to 
view public comments.
    Comments received timely will also be available for public 
inspection as they are received, generally beginning approximately 
three weeks after publication of a document, at the headquarters of the 
Centers for Medicare & Medicaid Services, 7500 Security Boulevard, 
Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 
a.m. to 4 p.m. EST. To schedule an appointment to view public comments, 
phone 1-800-743-3951.
    Internal Revenue Service. Comments to the IRS, identified by REG-
140038-10, by one of the following methods:
    <bullet> Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the instructions for submitting comments.
    <bullet> Mail: CC:PA:LPD:PR (REG-140038-10), room 5205, Internal 
Revenue Service, P.O. Box 7604, Ben Franklin Station, Washington, DC 
20044.
    <bullet> Hand or courier delivery: Monday through Friday between 
the hours of 8 a.m. and 4 p.m. to: CC:PA:LPD:PR (REG-140038-10), 
Courier's Desk, Internal Revenue Service, 1111 Constitution Avenue, 
NW., Washington DC 20224.
    All submissions to the IRS will be open to public inspection and 
copying in room 1621, 1111 Constitution Avenue, NW., Washington, DC 
from 9 a.m. to 4 p.m.

FOR FURTHER INFORMATION CONTACT: Amy Turner or Heather Raeburn, 
Employee Benefits Security Administration, Department of Labor, at 
(202) 693-8335; Karen Levin, Internal Revenue Service, Department of 
the Treasury, at (202) 622-6080; Jennifer Libster or Padma Shah, 
Centers for Medicare & Medicaid Services, Department of Health and 
Human Services, at (301) 492-4252.
    Customer Service Information: Individuals interested in obtaining 
information from the Department of Labor concerning employment-based 
health coverage laws may call the EBSA Toll-Free Hotline at 1-866-444-
EBSA (3272) or visit the Department of Labor's Web site (http://www.dol.gov/ebsa). In addition, information from HHS on private health 
insurance for consumers can be found on the Centers for Medicare & 
Medicaid Services (CMS) Web site (http://www.cms.hhs.gov/HealthInsReformforConsume/01_Overview.asp) and information on health 
reform can be found at http://www.healthcare.gov.

SUPPLEMENTARY INFORMATION:

I. Introduction

    The Departments of Health and Human Services (HHS), Labor, and the 
Treasury (the Departments) are taking a phased approach to issuing 
regulations and guidance implementing the revised Public Health Service 
Act (PHS Act) sections 2701 through 2719A and related provisions of the 
Patient Protection and Affordable Care Act (Affordable Care Act).\1\ 
Section 2715 of the PHS Act directs the Departments to develop 
standards for use by a group health plan and a health insurance issuer 
in compiling and providing a summary of benefits and coverage (SBC) 
that ``accurately describes the benefits and coverage under the 
applicable plan or coverage.'' Section 2715 of the PHS Act also directs 
the Departments to provide for the development of a uniform glossary. 
The statute directs the Departments, in developing such standards, to 
``consult with the National Association of Insurance Commissioners'' 
(referred to in this document as the ``NAIC''), ``a working group 
composed of representatives of health insurance-related consumer 
advocacy organizations, health insurance issuers, health care 
professionals, patient advocates including those representing

[[Page 52477]]

individuals with limited English proficiency, and other qualified 
individuals.''
---------------------------------------------------------------------------

    \1\ The Affordable Care Act also adds section 715(a)(1) to the 
Employee Retirement Income Security Act (ERISA) and section 
9815(a)(1) to the Internal Revenue Code (the Code) to incorporate 
the provisions of part A of title XXVII of the PHS Act into ERISA 
and the Code, and make them applicable to group health plans, and 
health insurance issuers providing health insurance coverage in 
connection with group health plans.
---------------------------------------------------------------------------

    As part of this required consultation, the NAIC convened the 
Consumer Information (B) Subgroup (NAIC working group), comprised of a 
diverse group of stakeholders.\2\ This working group met frequently 
each month for over one year while developing its recommendations. The 
NAIC working group created two subgroups--one focused on developing a 
uniform glossary of health insurance and medical terms and the other 
focused on developing standards for the SBC. All drafts were discussed 
and agreed to by the entire NAIC working group and then submitted to 
the full NAIC membership for a vote to submit the drafts as 
recommendations to the Departments. Throughout the process, NAIC 
working group draft documents and meeting notes were displayed on the 
NAIC's Web site for public review, and several interested parties filed 
formal comments. In addition to participation from the NAIC working 
group members, conference calls and in-person meetings were open to 
other interested parties and individuals and provided an opportunity 
for non-member feedback. The NAIC indicates that stakeholders from a 
diverse pool of backgrounds participated in working group conference 
calls.\3\
---------------------------------------------------------------------------

    \2\ A list of the NAIC working group members can be found at: 
http://www.naic.org/documents/committees_b_consumer_information_contacts.pdf.
    \3\ Records and other information relating to all of the 
meetings held by the NAIC working group can be found at: http://www.naic.org/committees_b_consumer_information.htm.
---------------------------------------------------------------------------

    As a result of this process, the NAIC working group recommended use 
of a uniform SBC template, as well as a uniform glossary, for the 
individual and group insurance markets. In developing these 
recommendations, the draft SBC template, including the coverage 
examples, and the draft uniform glossary underwent consumer testing,\4\ 
sponsored by both consumer and insurance industry groups. These tests 
were intended to assist in determining necessary adjustments to ensure 
the final product was consumer friendly.\5\ The Departments have 
received transmittals from the NAIC that include a recommended template 
for the SBC (referred to in this document as the ``SBC template'') \6\ 
with instructions, samples, and a guide for coverage examples 
calculations to be used in completing the SBC template. The NAIC 
transmittals also included a recommended uniform glossary of coverage 
and medical terms (referred to in this document as the ``uniform 
glossary''). The SBC template and uniform glossary include 
modifications made by the NAIC working group in response to the results 
of extensive consumer testing.
---------------------------------------------------------------------------

    \4\ The NAIC consulted readability experts and conducted 
consumer testing. The SBC format was designed to enhance to consumer 
understanding and usability. For example, use of vocabulary, such as 
``don't'' verses ``do not'' reflects intentional design based on 
feedback from consumer testing. These format choices reflect in 
part, the NAIC's efforts to address the statutory requirement that 
the form be ``culturally and linguistically appropriate.''
    \5\ Summaries of this consumer testing are available at: http://www.naic.org/documents/committees_b_consumer_information_101012_ahip_focus_group_summary.pdf; http://www.naic.org/documents/committees_b_consumer_information_110603_ahip_bcbsa_consumer_testing.pdf; http://www.naic.org/documents/committees_b_consumer_information_101014_consumers_union.pdf 
(a more detailed summary of which is accessible at: http://prescriptionforchange.org/pdf/CU_Consumer_Testing_Report_Dec_2010.pdf); and http://www.naic.org/documents/committees_b_consumer_information_110603_consumers_union_testing.pdf.
    \6\ In their materials, the NAIC uses the phrase ``Summary of 
Coverage'' to describe the SBC template. However, the Departments 
use the term ``Summary of Benefits and Coverage'' in the proposed 
regulations and this document. Both of these terms are meant to 
refer to the same document (located in Appendix A-1 of this 
document).
---------------------------------------------------------------------------

    The 2011 proposed regulations and this document follow the 
recommendations made by the NAIC and incorporate the documents drafted 
by the NAIC, including the SBC template (with instructions, sample 
language, and a guide for coverage examples calculations to be used in 
completing the SBC template) and the uniform glossary. The Appendices 
do not include a sample coverage example calculation for breast cancer 
in the individual market that was transmitted by the NAIC. Upon review, 
it appeared that some of the data in the example might be subject to 
copyright protection. Moreover, the sample coverage example calculation 
provided by the NAIC was limited to breast cancer in the individual 
market and did not address the other two coverage examples--maternity 
coverage and diabetes. Finally, particular coding information and 
pricing information included in the sample would change annually, which 
would result in the data included in the sample becoming outdated 
relatively quickly. Accordingly, HHS is publishing on its Web site (at 
http://cciio.cms.gov) the coding and pricing information necessary to 
perform coverage example calculations for all three coverage examples. 
HHS will update this information annually.
    Instead of proposing possible changes to the NAIC's proposed SBC 
template and related materials at this time, this document proposes to 
incorporate the NAIC working group's recommended materials as 
transmitted (with the exception of the sample coverage example, 
explained above), and invites public comment. The Departments recognize 
that changes to the SBC template may be appropriate to accommodate 
various types of plan and coverage designs, to provide additional 
information to individuals, or to improve the efficacy of the 
disclosures recommended by the NAIC. In addition, the SBC template and 
related documents were drafted by the NAIC primarily for use by health 
insurance issuers.\7\ The NAIC states in its transmittal letter that 
additional modifications may be needed for some group health plans. 
Consequently, comments are requested on these issues specifically and 
on the SBC template, sample completed SBC, instructions for both group 
health plan coverage and individual health insurance coverage, sample 
language for the ``Why this Matters'' section of the SBC, guide for 
coverage examples calculations, and on the uniform glossary generally. 
After the public comment period, the Departments will finalize these 
documents. Consistent with PHS Act section 2715(c), the Departments 
will periodically review and update these documents as appropriate, 
taking into account public comments.
---------------------------------------------------------------------------

    \7\ National Association of Insurance Commissioners, Consumer 
Information Working Group, December 17, 2010 Letter to the 
Secretaries. Available at http://www.naic.org/documents/committees_b_consumer_information_ppaca_letter_to_sebelius.pdf.
---------------------------------------------------------------------------

II. Proposal

    This document proposes an SBC template (with instructions, samples, 
and a guide for coverage examples calculations to be used in completing 
the SBC template), and the uniform glossary, to comply with the 
disclosure requirements of PHS Act section 2715, as authorized by the 
Departments pursuant to paragraph (a)(4) of the 2011 proposed 
regulations. The SBC template, sample completed SBC, instructions for 
both group health plan coverage and individual health insurance 
coverage, sample language for the ``Why This Matters'' section of the 
SBC, guide for coverage examples calculations, and uniform glossary are 
identical to the documents transmitted by the NAIC. These items are 
contained in the Appendices to this document.
    In addition to the materials in the Appendices that are proposed in 
this document, HHS is providing (at http://cciio.cms.gov) the specific 
information necessary to simulate benefits covered under the plan or 
policy for the

[[Page 52478]]

coverage examples portion of the SBC (including specific medical items 
and services, dates of service, billing codes, and allowed charges for 
each claim in the three specified benefits scenarios). HHS will update 
this information annually on its Web site. The Departments propose that 
plans and issuers are not required to update their coverage examples 
for SBCs provided before the date that is 90 days after the date that 
HHS provides this updated information. That is, 90 days after HHS 
updates the information, SBCs that are otherwise required to be 
provided under paragraph (a) of the proposed rules should take into 
account the new information when providing coverage examples. For 
example, if HHS releases updated information on September 15 of a year, 
SBCs required to be provided on or after December 14 of that year under 
the rules of paragraph (a) of the proposed rules would need to include 
coverage examples calculated using the new information. However, these 
updates alone will not be considered a material modification under 
paragraph (b) of the 2011 proposed regulations. Comments are invited on 
this information as well, including the annual update provision. The 
preamble to the 2011 proposed regulations contains a request for 
comment regarding various approaches to providing the coverage 
examples. Commenters addressing the requirement to provide updated 
coverage examples are encouraged to consider how updates would be made 
to the coverage examples under these various approaches and what 
additional instructions should be added to address updates and a 
possible phased-in approach to implementation discussed in the preamble 
to the 2011 proposed regulations.
    With respect to the element of the SBC regarding a statement about 
whether a plan or coverage provides minimum essential coverage (as 
defined under section 5000A(f) of the Code) and whether the plan's or 
coverage's share of the total allowed costs of benefits provided under 
the plan or coverage meets applicable minimum value requirements 
(minimum essential coverage statement),\8\ because this content is not 
relevant until other elements of the Affordable Care Act are 
implemented, this statement is not in the NAIC recommendations. For the 
same reason, and as discussed more fully in the preamble to the 2011 
proposed regulations, the minimum essential coverage statement is not 
required to be in the SBC until the plan or coverage is required to 
provide an SBC with respect to coverage beginning on or after January 
1, 2014. As provided in the preamble to the 2011 proposed regulations, 
comments are requested on how employers might provide the information 
included in the minimum essential coverage statement and other plan-
level reporting in a manner that minimizes duplication and burden.
---------------------------------------------------------------------------

    \8\ PHS Act section 2715(b)(3)(G) provides that this statement 
must indicate whether the plan or coverage (1) provides minimum 
essential coverage (as defined under section 5000A(f) of the Code) 
and (2) ensures that the plan's or coverage's share of the total 
allowed costs of benefits provided under the plan or coverage is not 
less than 60 percent of such costs.
---------------------------------------------------------------------------

    In addition, the SBC template recommended by the NAIC and located 
in Appendix A-1 of this document includes Web sites for individuals to 
access the uniform glossary, for information about prescription drug 
coverage, and for information about the plan or coverage provider 
network. The Departments note, however, these Web sites are not working 
Web sites. Plans and issuers would need to modify this aspect of the 
SBC template to include relevant, working Web addresses (for the 
uniform glossary, this may be the Web address of either the Department 
of Labor or HHS Web site, or on the plan's or issuer's own Web site). 
The Departments invite comment on whether this statement in the SBC 
template regarding the electronically available uniform glossary should 
be modified to include a statement that the uniform glossary is 
available in paper form upon request.

III. Solicitation of Comments

    The Departments solicit comments generally on the SBC template and 
related documents and the uniform glossary included in the Appendices, 
as well as on specific issues set forth below (including on what 
modifications, if any, are needed for group health plans to use the SBC 
template).
    The NAIC stated in the December 2010 transmittal letter that the 
working group intentionally designed the layout and color of the SBC 
template based on consumer testing to make the document more readable 
and to facilitate comparison of different plan and coverage options. 
The Departments recognize, however, that color printing may be costly 
for some plans and issuers and therefore propose that a plan or issuer 
will be compliant if it uses either the color version (available on the 
Web sites of the Departments of Labor and HHS),\9\ as recommended by 
the NAIC, or the grayscale version (included in the Appendices to this 
document). In addition, the Departments note that while the NAIC-
recommended SBC template is only three double-sided pages, the 
Departments are proposing that a completed SBC may be four double-sided 
pages in length. The SBC template reserves space to ensure that a plan 
or issuer with different benefit designs (such as multiple, tiered 
provider networks) could provide all the necessary information, and 
that additional coverage examples could be added in the future, within 
four double-sided pages. (See the preamble to the 2011 proposed 
regulations for a request for comment regarding various approaches to 
providing the coverage examples.)
---------------------------------------------------------------------------

    \9\ See http://www.dol.gov/ebsa or http://cciio.cms.gov.
---------------------------------------------------------------------------

    The Departments are interested in any general comments regarding 
the proposed SBC template, sample completed SBC, instructions for both 
group health plan coverage and individual health insurance coverage, 
sample language for the ``Why This Matters'' section of the SBC, guide 
for coverage examples calculations, and uniform glossary. In making 
this request for comment, the Departments note that the purpose of PHS 
Act section 2715 is to provide individuals and plan participants with a 
brief summary of plan or policy benefits and coverage so that they may 
more easily compare health care coverage and better understand the 
terms of coverage (or exceptions to the coverage). The SBC is intended 
to assist individuals purchasing coverage in the individual market in 
comparing the benefits and coverage of different individual policies 
offered by insurance issuers. Likewise, the SBC is intended to assist 
employees who are offered group coverage to compare among different 
employer-provided health care options or to compare their employer's 
options with other coverage for which they may be eligible, such as a 
spouse's or dependent's offer of employer-provided health care 
coverage, a former employer's COBRA continuation coverage,\10\ or a 
policy on the individual market.
---------------------------------------------------------------------------

    \10\ As defined in 26 CFR 54.9801-2, 29 CFR 2590.701-2, and 45 
CFR 144.103, COBRA means Title X of the Consolidated Omnibus Budget 
Reconciliation Act of 1985, as amended.
---------------------------------------------------------------------------

    In order to make it as easy as possible for individuals to 
understand the terms of their own coverage and compare coverage and 
benefits efficiently and accurately, the statute provides for, and the 
NAIC recognized the importance of, presenting the SBC in a uniform 
format. We invite comments on how this statutory requirement should be

[[Page 52479]]

applied, including the nature and extent of the uniformity that should 
be required in the specific language of the SBC and the manner and 
sequence in which the information in the SBC is presented. We ask that 
any comments proposing that flexibility be permitted in aspects of the 
presentation of the SBC explicitly address the potential positive or 
negative effects on individuals' ability to effectively compare 
benefits and coverage among and across individual policies and group 
health plans.
    The Departments also invite comments on the following specific 
issues:
    1. The SBC template is intended to be used by all types of plan or 
coverage designs. The Departments are interested in comments related to 
issues that may arise from the use of this template for different types 
of plan or coverage designs (for example, designs using tiered provider 
networks or group health plans that may use multiple issuers or service 
providers to provide or administer different categories of benefits 
within a benefit package).
    2. The Departments are interested in comments regarding any 
modifications needed for use by group health plans (e.g., with respect 
to disclosure regarding cost of coverage and changes in terminology 
required for self-insured plans, such as use of the term ``plan year'' 
instead of ``policy period'').
    3. The Departments are interested in comments regarding whether the 
content of the SBC should require inclusion of additional information, 
such as information regarding any preexisting condition exclusion under 
the plan or policy,\11\ status as a grandfathered health plan,\12\ or 
other information that might be important for individuals to know about 
their coverage and how the SBC template could be modified to ensure 
effective disclosure of these additional elements, while respecting the 
statutory formatting requirements. For example, comments are requested 
on whether a simplified reporting method, such as a checkbox, could be 
used to disclose preexisting condition exclusions and grandfather 
status.
---------------------------------------------------------------------------

    \11\ Note: The general notice of preexisting condition exclusion 
and the individual notice of preexisting condition exclusion at 26 
CFR 54.9801-3(c) and (e), 29 CFR 2590.701-3(c) and (e), and 45 CFR 
146.111(c) and (e), were published as part of the Departments' HIPAA 
portability regulations on December 30, 2004, 69 FR 78720.
    \12\ Note: Under paragraph (a)(2) of the Departments' interim 
final regulations regarding status as a grandfathered health plan, 
to maintain grandfather status, group health plans and health 
insurance coverage must include a statement in any plan materials 
describing the benefits provided that the plan or coverage believes 
it is a grandfathered health plan. Model language is provided. See 
26 CFR 54.9815-1251T(a)(2), 29 CFR 2590.715-1251(a)(2), and 45 CFR 
147.140(a)(2), published in the Federal Register on June 17, 2010, 
75 FR 34538.
---------------------------------------------------------------------------

    4. The fourth page of the SBC template includes a list of services 
that plans and issuers must indicate as either excluded or covered in 
the ``Excluded Services & Other Covered Services'' chart. The 
Departments solicit comments on whether services should be added or 
removed from this list, as well as whether the disclosure stating that 
the list is not complete is adequate.
    5. The SBC template includes a disclosure on the first page 
indicating to consumers that the SBC is not the actual policy and does 
not include all of the coverage details found in the actual policy. The 
Departments solicit comments on whether this disclosure is adequate.
    The uniform glossary is also included in Appendix E of this 
document. The Departments propose that plans and issuers cannot make 
any modifications to this glossary. The uniform glossary was developed 
to facilitate and enhance consumer comprehension and is not intended to 
provide legal or contractual definitions that necessarily apply 
accurately, without modification, to every plan or coverage. The NAIC 
consumer testing found that certain terms relating to cost-sharing 
provisions were particularly difficult for consumers to understand. As 
a result, the NAIC developed diagrams to accompany the textual 
definitions of these terms. The Departments solicit comments on the 
uniform glossary, including its terms and definitions, and whether 
other terms should be added to the glossary, as well as whether any of 
the terms would be considered inaccurate or misleading based on a 
particular plan or coverage design.
    Comments are also invited on the standards set forth in the 2011 
proposed regulations. To comment on the 2011 proposed regulations, see 
the comment section of the 2011 proposed regulations, published 
elsewhere in this issue of the Federal Register.

IV. Paperwork Reduction Act

    According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) 
(PRA), no persons are required to respond to a collection of 
information unless such collection displays a valid OMB control number. 
The Department notes that a Federal agency cannot conduct or sponsor a 
collection of information unless it is approved by OMB under the PRA, 
and displays a currently valid OMB control number, and the public is 
not required to respond to a collection of information unless it 
displays a currently valid OMB control number. See 44 U.S.C. 3507. 
Also, notwithstanding any other provisions of law, no person shall be 
subject to penalty for failing to comply with a collection of 
information if the collection of information does not display a 
currently valid OMB control number. See 44 U.S.C. 3512.
    This document relates to the information collection request (ICR) 
contained in a proposed regulation titled ``Summary of Benefits and 
Coverage and the Uniform Glossary,'' which is published elsewhere in 
today's issue of the Federal Register. For a discussion of the hour and 
cost burden associated with the ICR, please see the notice of proposed 
rulemaking.

Sarah Hall Ingram,
Acting Deputy Commissioner for Services and Enforcement, Internal 
Revenue Service.

    Signed this 15th day of August, 2011.
Phyllis C. Borzi,
Assistant Secretary, Employee Benefits Security Administration, 
Department of Labor.

    Dated: July 28, 2011.
Donald Berwick,
Administrator, Centers for Medicare & Medicaid Services.

    Dated: August 9, 2011.
Kathleen Sebelius,
Secretary, Department of Health and Human Services.

V. Appendices

Table of Contents

A. Summary of Benefits and Coverage (SBC)
    Appendix A-1. SBC Template
    Appendix A-2. Sample Completed SBC (Individual Health Insurance 
Coverage)
B. Instructions for Completing the SBC
    Appendix B-1. Instructions--Group Health Plan Coverage
    Appendix B-2. Instructions--Individual Health Insurance Coverage
C. Sample Language--Why This Matters section of SBC (Page 1)
    Appendix C-1. Why This Matters language for ``Yes'' Answers
    Appendix C-2. Why This Matters language for ``No'' Answers
D. Coverage Examples Calculations
    Appendix D. Guide for Coverage Examples Calculations
E. Uniform Glossary
    Appendix E. Uniform Glossary of Coverage and Medical Terms

Overview of Appendices

    As stated earlier in this document, the NAIC transmitted the work 
of the NAIC Working Group to the Departments. The Appendices to this 
document include the SBC documents drafted by the NAIC in their 
entirety, with the exception of the sample coverage example calculation 
for breast cancer in the

[[Page 52480]]

individual market, as explained earlier in this document.
    Appendix A-1 contains an SBC template, as developed by the NAIC 
Working Group. The NAIC Working Group incorporated all of their 
recommendations contained in the multiple transmittals to the 
Departments over the last several months in their final recommended SBC 
template.
    Appendix A-2 contains a sample completed SBC, using information for 
a sample individual health insurance policy. While the sample completed 
SBC may not align perfectly with the instructions in every way, the 
document is useful in providing a general illustration of a completed 
SBC for a sample insurance policy.
    Appendices B-1 and B-2 contain instructions for group health 
coverage and individual health insurance coverage, respectively, to use 
in completing the SBC template. The Departments are publishing the 
sample completed SBC and the instructions to facilitate compliance with 
the requirements of the 2011 proposed regulations and this document.
    The SBC instructions include language that must be used when 
completing the ``Why This Matters'' column on the first page of the SBC 
template. Depending on the design of the policy or plan, there are two 
language options provided in Appendices C-1 (for when the answer in the 
applicable row is ``yes'') and C-2 (for when the answer in the 
applicable row is ``no''). Appendices C-1 and C-2 provide an example of 
how this column will look when populated with the required language, as 
applicable depending upon the terms of the plan or coverage.
    Appendix D contains a guide for use by a plan or issuer in 
compiling information related to the coverage examples. This document, 
together with information provided in Microsoft Excel format by HHS at 
http://cciio.cms.gov, comprises all the information necessary to 
perform coverage example calculations for all three coverage examples. 
HHS will update the information on its Web site annually. With respect 
to these annual updates, the Departments propose that 90 days after HHS 
updates the information, SBCs that are otherwise required to be 
provided under paragraph (a) of the 2011 proposed rules would take into 
account the new information when providing coverage examples.
    Finally, Appendix E contains the Uniform Glossary of Health 
Insurance and Medical Terms.
    The Departments invite comments on all of the documents in the 
Appendices to this document and their use in relation to the 
requirements of the 2011 proposed regulations and this document.
BILING CODE 4120-01-P

[[Page 52481]]

[GRAPHIC] [TIFF OMITTED] TP22AU11.000


[[Page 52482]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.001


[[Page 52483]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.002


[[Page 52484]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.003


[[Page 52485]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.004


[[Page 52486]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.005


[[Page 52487]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.006


[[Page 52488]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.007


[[Page 52489]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.008


[[Page 52490]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.009


[[Page 52491]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.010


[[Page 52492]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.011


[[Page 52493]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.012


[[Page 52494]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.013


[[Page 52495]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.014


[[Page 52496]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.015


[[Page 52497]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.016


[[Page 52498]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.017


[[Page 52499]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.018


[[Page 52500]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.019


[[Page 52501]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.020


[[Page 52502]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.021


[[Page 52503]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.022


[[Page 52504]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.023


[[Page 52505]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.024


[[Page 52506]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.025


[[Page 52507]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.026


[[Page 52508]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.027


[[Page 52509]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.028


[[Page 52510]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.029


[[Page 52511]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.030


[[Page 52512]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.031


[[Page 52513]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.032


[[Page 52514]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.033


[[Page 52515]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.034


[[Page 52516]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.035


[[Page 52517]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.036


[[Page 52518]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.037


[[Page 52519]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.038


[[Page 52520]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.039


[[Page 52521]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.040


[[Page 52522]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.041


[[Page 52523]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.042


[[Page 52524]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.043


[[Page 52525]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.044


[[Page 52526]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.045


[[Page 52527]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.046


[[Page 52528]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.047


[[Page 52529]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.048


[[Page 52530]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.049


[[Page 52531]]


[GRAPHIC] [TIFF OMITTED] TP22AU11.050

[FR Doc. 2011-21192 Filed 8-17-11; 11:15 am]
BILLING CODE 4120-01-C


</pre><script data-cfasync="false" src="/cdn-cgi/scripts/5c5dd728/cloudflare-static/email-decode.min.js"></script></body>
</html>