Summary of Benefits and Coverage and Uniform Glossary

Forms and Documents

Document Name	Status
Form CMS-10407 SBC Disclosure Form and Instruction	Modified
CMS-10407 60-day public comment and response_2-12-15 508MM.pdf Supplementary Document	2015-02-23
CMS-10407 Supporting Statement 30-day_2-12-15_508MM.pdf Supporting Statement A	2015-02-23

IC Document Collections

IC ID	Document Title	Status
201038	Deemed Compliance Reporting	Modified
199007	SBC Disclosure Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1146	ICR Reference No: 201502-0938-007
Status: Historical Active	Previous ICR Reference No: 201304-0938-007
Agency/Subagency: HHS/CMS	Agency Tracking No: 19325
Title: Summary of Benefits and Coverage and Uniform Glossary
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/18/2015
	Date Received in OIRA: 02/27/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	36 Months From Approved	05/31/2015
Responses	16,012,292	0	13,058,000
Time Burden (Hours)	322,731	0	300,220
Cost Burden (Dollars)	1,592,793	0	1,300,000

---

Abstract: The Patient Protection and Affordable Care Act, Pub. L. 111-148, was signed into law on March 23, 2010, and the Health Care and Education Reconciliation Act of 2010, Pub. L. 111-152, was signed into law on March 30, 2010 (these are collectively known as the "Affordable Care Act"). The Affordable Care Act amends the Public Health Service Act (PHS Act) by adding section 2715 "Development and Utilization of Uniform Explanation of Coverage Documents and Standardized Definitions." Section 2715 directs the Secretary, in consultation with the National Association of Insurance Commissioners and a working group comprised of stakeholders, to develop standards for use by a group health plan and a health insurance issuer in compiling and providing to applicants, enrollees, and policyholders and certificate holders a summary of benefits and coverage (SBC) that accurately describes the benefits and coverage under the applicable plan or coverage. Section 2715 also directs the Secretary to provide for the development of standards for the defintions of terms used in health insuance. Finally, section 2715 requires 60-days advance notice of any material modification in any of the terms of the plan or coverage that is not reflected in the most recently provided SBC. To implement these disclosure requirements, the final rule would require a collection of information by health insurance issuers in the group and individual markets and third-party administrators. Collection of information requirements relate to the provision of the following: 1. Summary of benefits and coverage (SBC) 2. Coverage examples (as a component of each SBC) 3. A uniform glossary of health coverage and medical terms (uniform glossary) 4. Notice of modifications

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 Title 1, Subtitle A, Sec. 1001 Name of Law: Amendments to the Public Health Service Act
   US Code: 42 USC Sec 300gg-21 Name of Law: Development and Utilization of Uniform Explanation of Coverage Documents & Standardized Definitions
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 69854	11/24/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 9703	02/24/2015
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
SBC Disclosure	CMS-10407, CMS-10407, CMS-10407, CMS-10407, CMS-10407, CMS-10407, CMS-10407, CMS-10407, CMS-10407, CMS-10407	Maternity Scenario ,   Diabetes_Narrative ,   Diabetes_Scenario ,   Instructions Group ,   Instructions Individual ,   Maternity_Narrative ,   Sample Completed SBC ,   Uniform Glossary ,   Summary_of_Benefit_and_Coverage_Template (4-25-13) ,   Appendix A
Deemed Compliance Reporting

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	16,012,292	13,058,000	0	0	2,954,292	0
Annual Time Burden (Hours)	322,731	300,220	0	0	22,511	0
Annual Cost Burden (Dollars)	1,592,793	1,300,000	0	0	292,793	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The total hour burden estimate associated with this collection has increased 22,511 hours. Estimates have been adjusted to account for new estimates of the number of issuers, plans, participants and beneficiaries affected by the information collection.

---

Annual Cost to Federal Government: $21,050

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/27/2015

---