GUIDANCE ON SBC COVERAGE EXAMPLE

Guidance on SBC Coverage Example

The Center for Consumer Information & Insurance Oversight (CCIIO) has temporarily suspended the completion of a new third coverage example for a simple fracture for the 2017 Summary of Benefits and Coverage (SBC).

Until further notice, self-funded plans and insurers should enter default values of “$0” on the Plans and Benefit template for each field for this coverage example, according to the CCIIO, which is part of the Centers for Medicare and Medicaid Services.

Self-funded plans and insurers may continue to use the Coverage Example Calculator approved for plan year 2016 to calculate data for the two other SBC coverage examples: “Having a Baby” and “Managing Diabetes.”

For more information on SBCs, follow this link.