### 52475 Federal Register / Vol. 76, No. 162 / Monday, August 22, 2011 / Proposed Rules

that is consistent with the rules of paragraph (a)(4) of this section.

(c) Uniform glossary —(1) In general. A group health plan, and a health insurance issuer offering group health insurance coverage, must make available to participants and beneficiaries, and a health insurance issuer offering individual health insurance coverage must make available to applicants, policyholders, and covered dependents, the uniform glossary described in paragraph (c)(2) of
this section in accordance with the appearance and format requirements of paragraphs (c)(3) and (c)(4) of this
section.

(2) Health-coverage-related terms and
medical terms. The uniform glossary must provide uniform definitions, specified by the Secretary in guidance, for the following health-coverage-related
terms and medical terms:

(i) Allowed amount, appeal, balance billing, co-insurance, complications of pregnancy, co-payment, deductible, durable medical equipment, emergency medical condition, emergency medical transportation, emergency room care, emergency services, excluded services, grievance, habilitation services, health insurance, home health care, hospice services, hospitalization, hospitaloutpatient care, in-network coinsurance, in-network co-payment,medically necessary, network, nonpreferred provider, out-of-network coinsurance, out-of-network co-payment, out-of-pocket limit, physician services, plan, preauthorization, preferred provider, premium, prescription drug coverage, prescription drugs, primary care physician, primary care provider, provider, reconstructive surgery, rehabilitation services, skilled nursing care, specialist, usual customary and reasonable (UCR), and urgent care; and

(ii) Such other terms as the Secretary determines are important to define so that individuals and employers may compare and understand the terms of coverage and medical benefits (including any exceptions to those benefits), as specified in guidance.

(3) Appearance. A group health plan, and a health insurance issuer, must provide the uniform glossary with the appearance authorized in guidance, ensuring that the uniform glossary is presented in a uniform format and utilizes terminology understandable by the average plan enrollee (or, in the case of individual market coverage, an average individual covered under a health insurance policy).

(4) Form and manner. A plan or issuer must make the uniform glossary described in this paragraph (c) available upon request, in either paper or electronic form (as requested), within seven days of the request. (Under the rules of paragraph (a) of this section, the form authorized in guidance for the SBC will disclose to participants, beneficiaries, and individuals covered under an individual policy their rights to request a copy of the uniform glossary.)

(d) Preemption. For purposes of this section, the provisions of section 2724 of the PHS Act continue to apply with respect to preemption of State law. In addition, with respect to the standards for providing an SBC required under paragraph (a) of this section, State laws that require a health insurance issuer to provide an SBC that supplies less information than required under paragraph (a) of this section are preempted.

(e) Failure to provide. A health
insurance issuer or a non-Federal governmental health plan that willfully fails to provide information required under this section is subject to a fine of not more than $1,000 for each such failure. A failure with respect to each
covered individual constitutes a separate offense for purposes of this paragraph (e). HHS will enforce these provisions in a manner consistent with 45 CFR 150.101 through 150.465.

(f) Applicability date. This section is applicable beginning March 23, 2012.

See § 147.140(d) of this chapter, providing that this section applies to grandfathered health plans.

[FR Doc. 2011–21193 Filed 8–17–11; 11:15 am]

**BILLING CODE 4120–01–P**

**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:

• Federal eRulemaking Portal: http:// www.regulations.gov. Follow the instructions for submitting comments.

• E-mail: E–OHPSCA2715.EBSA @dol.gov.

• 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


### 52476 Federal Register / Vol. 76, No. 162 / Monday, August 22, 2011 / Proposed Rules

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. 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:

• Federal eRulemaking Portal: http:// www.regulations.gov. Follow the instructions for submitting comments.

• Mail: CC:PA:LPD:PR (REG–140038– 10), room 5205, Internal Revenue Service, P.O. Box 7604, Ben Franklin Station, Washington, DC 20044.

• 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


### 52477 Federal Register / Vol. 76, No. 162 / Monday, August 22, 2011 / Proposed Rules

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.

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). 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. individuals with limited English proficiency, and other qualified
individuals.’’

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

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.

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.

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


### 52478 Federal Register / Vol. 76, No. 162 / Monday, August 22, 2011 / Proposed Rules

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

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 beadded in the future, within four doublesided pages. (See the preamble to the 2011 proposed regulations for a request for comment regarding various approaches to providing the coverage examples.)

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 tocompare among different employerprovided 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.

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


### 52479 Federal Register / Vol. 76, No. 162 / Monday, August 22, 2011 / Proposed Rules

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. 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.

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


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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.

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[FR Doc. 2011–21192 Filed 8–17–11; 11:15 am]

**BILLING CODE 4120–01–C**