Summary of Benefits and Coverage and Uniform Glossary (CMS-10407)

ICR 201602-0938-012

OMB: 0938-1146

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2016-04-05
Supplementary Document
2016-02-26
Supplementary Document
2016-02-26
Supporting Statement A
2016-04-06
IC Document Collections
IC ID
Document
Title
Status
201038
Modified
199007 Modified
ICR Details
0938-1146 201602-0938-012
Historical Active 201506-0938-006
HHS/CMS 19325
Summary of Benefits and Coverage and Uniform Glossary (CMS-10407)
Revision of a currently approved collection   No
Regular
Approved with change 04/06/2016
Retrieve Notice of Action (NOA) 02/29/2016
  Inventory as of this Action Requested Previously Approved
04/30/2019 36 Months From Approved 10/31/2018
41,289,563 0 16,012,292
325,333 0 322,731
4,116,476 0 1,592,793

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

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
  
None

Not associated with rulemaking

  80 FR 75488 12/02/2015
81 FR 9860 02/26/2016
Yes

2
IC Title Form No. Form Name
Deemed Compliance Reporting
SBC Disclosure CMS-10407, CMS-10407, CMS-10407, CMS-10407, CMS-10407, CMS-10407, CMS-10407, CMS-10407, CMS-10407, CMS-10407, CMS-10407 , CMS-10407, CMS-10407, CMS-10407, CMS-10407, CMS-10407 Maternity Scenario ,   Diabetes Narrative ,   Coverage Examples - Narrative Foot Fracture ,   Simple Fracture ,   Coverage Examples Calculator ,   Coverage Examples Calculator ,   Group Instructions ,   Having a baby ,   Instructions - Individual ,   Managing diabetes ,   SBC Glossary Anchor ,   Uniform Glossary ,   What the plan covers and What you pay (No Answers) ,   Completed SBC Sample ,   Blank Template ,   What the plan covers and what you play (Yes Answes)

  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 41,289,563 16,012,292 0 0 25,277,271 0
Annual Time Burden (Hours) 325,333 322,731 0 0 2,602 0
Annual Cost Burden (Dollars) 4,116,476 1,592,793 0 0 2,523,683 0
No
No
The total burden hour estimate associated with this collection has increased by 2,602 hours (from 322,731 to 325,333). Estimates have been adjusted to account for changes in previously calculated values.

$20,480
No
No
Yes
No
No
Uncollected
Jamaa Hill 301 492-4190

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
02/29/2016


© 2024 OMB.report | Privacy Policy