SUMMARY OF BENEFITS COVERAGE (SBC)...IT'S ON YOU

Under PPACA (Health Reform), you as an employer, starting with your first open enrollment period after September 23, 2012, will be required to issue a Summary Of Benefits Coverage (SBC) to all health plan participants.  This is an approximate 4 page (front and back) document explaining the key benefits and coverage of the employer plan(s).  In most cases the insurance carrier will provide either copies or a link to a file in PDF format in order to download and distribute.  According to PPACA, the responsibility to distribute the SBC to plan participants lies with the employer group.  This is not to say, that at some point, carriers may decide to simply issue these directly to the plan participants as a courtesy to their clients. 

COMPARATIVE EFFECTIVENESS FEE (TAX?)

Starting in October 1, 2012 employers will pay $1 per participant on your health plan per year to fund Comparative Effectiveness Research.  The dollars will go to the Patient-Centered Outcomes Research Trust Fund and will fund a new organization call the Patient Centered Outcomes Research Institute (PCORI).  This amount will increase to $2 per participant per year in 2013.

The idea behind the fee or tax is that these dollars will go to conduct comparative effectiveness research of various medical interventions and publicly disseminate them. Whether or not this fee will go to fund decisions on your personal healthcare is yet to be seen.