In November 2019, the DOL issued updated summary of benefits and coverage (SBC) templates, instructions, and related materials for use in completing SBCs, as required under the Affordable Care Act (ACA) (see Practice Note, Summaries of Benefits and Coverage Under the ACA). The updated materials:

The updated SBC materials are for use in plan or policy years beginning on or after January 1, 2021.

In addition, HHS issued updated SBC templates, instructions, and related materials, including a crosswalk of changes that outlines revisions to its SBC calculator and examples.

The DOL's updated SBC materials include sample completed and non-completed versions of the SBC templates. A section of the updated templates addressing minimum essential coverage (MEC):

(See Practice Note, Information Reporting for Employers That Self-Insure and Insurers (Section 6055): Minimum Essential Coverage.)

By contrast, the April 2016 templates – issued prior to the TCJA – stated that individuals who lacked MEC for a month would need to make an individual mandate payment (unless they qualified for an exemption).

The updated templates include other relatively minor changes. For example, the updated templates add a "Not Applicable" option for the question concerning whether the plan meets the ACA's minimum value standards (see Practice Note, Employer Mandate Under the ACA: Overview: Minimum Value). (A related change to the SBC instructions explains that the concept of minimum value is not relevant regarding individual market coverage, and so insurers that issue individual market coverage should answer "not applicable".) In addition, the non-completed template now contains "total example cost" values for the template's three treatment examples.

The HHS's SBC materials include sample completed SBCs illustrating arrangements with zero cost-sharing and limited cost-sharing.

The DOL also updated the instructions for completing the SBC, both for group health plan and individual health insurance coverage. The updated instructions include new MEC language reflecting the TCJA's reduction to zero of the individual mandate penalty. As noted, the instructions add "Not Applicable" as an option for the question on minimum value standards.

The updated instructions also add a clarification regarding a rounding rule for dollar values in the context of cost-sharing and out-of-pocket limits. The instructions provide that if applying the rounding rules results in an amount that exceeds the actual out-of-pocket limit for self-only coverage, the actual out-of-pocket limit should be used instead. A related example explains this change.

Regarding the uniform glossary, which must be included in the SBC, the DOL removed the definition of "Individual Responsibility Requirement". Concerning the uniform glossary's definition of MEC, the DOL:

(For more information, see Practice Note, Summaries of Benefits and Coverage Under the ACA: Standardized Insurance and Medical Terms; Uniform Glossary.)

As in the past, electronically provided documents can link directly to glossary terms on the government's healthcare.gov website using a list of anchors.

The DOL also made other minor changes, including:

Plans and insurers will need to use the updated SBC templates and related documents for plan and policy years beginning on or after January 1, 2021. Additional SBC documents available on HHS's website – which include an updated SBC calculator guide and narratives – also must be used on this timetable.