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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10407 Simple Fracture	Form and Instruction	Modified	Available
Form CMS-10407 SBC Glossary Anchor	Form	Modified	Available
Form CMS-10407 Managing diabetes	Form and Instruction	Modified	Available
Form CMS-10407 Having a baby	Form and Instruction	Modified	Available
Form CMS-10407 Coverage Examples Calculator	Form	Modified	Available
Form CMS-10407 Coverage Examples Calculator	Form and Instruction	Modified	Available
Form CMS-10407 Coverage Examples - Narrative Foot Fracture	Form	Modified	Available
Form CMS-10407 Blank Template	Form and Instruction	Modified	Available
Form CMS-10407 Completed SBC Sample	Form and Instruction	Modified	Available
Form CMS-10407 Instructions - Individual	Form and Instruction	Modified	Available
Form CMS-10407 Group Instructions	Form and Instruction	Modified	Repair queued
Form CMS-10407 What the plan covers and what you play (Yes Answes)	Form and Instruction	Modified	Available
Form CMS-10407 What the plan covers and What you pay (No Answers)	Form and Instruction	Modified	Available
Form CMS-10407 Uniform Glossary	Form	Modified	Available
Form CMS-10407 Diabetes Narrative	Form and Instruction	Modified	Available
Form CMS-10407 Maternity Scenario	Form and Instruction	Modified	Available
CMS-10407 - SBC Response to Comments 4 5 16 clean.docx	Supplementary Document	Uploaded 2016-04-05	Available
CMS-10407 - Appendix B Comment NAIC Consumer Info FINAL COMBINED.pdf	Supplementary Document	Uploaded 2016-02-26	Available
CMS-10407 - Appendix A 60-day public comment and response.docx	Supplementary Document	Uploaded 2016-02-26	Available
CMS-10407.Final Supporting Statement (4-6-16).docx	Supporting Statement A	Uploaded 2016-04-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
201038	Deemed Compliance Reporting		Modified
199007	SBC Disclosure	Form and Instruction	Modified	Simple Fracture
199007	SBC Disclosure	Form	Modified	SBC Glossary Anchor
199007	SBC Disclosure	Form and Instruction	Modified	Managing diabetes
199007	SBC Disclosure	Form and Instruction	Modified	Having a baby
199007	SBC Disclosure	Form	Modified	Coverage Examples Calculator
199007	SBC Disclosure	Form and Instruction	Modified	Coverage Examples Calculator
199007	SBC Disclosure	Form	Modified	Coverage Examples - Narrative Foot Fracture
199007	SBC Disclosure	Form and Instruction	Modified	Blank Template
199007	SBC Disclosure	Form and Instruction	Modified	Completed SBC Sample
199007	SBC Disclosure	Form and Instruction	Modified	Instructions - Individual
199007	SBC Disclosure	Form and Instruction	Modified	Group Instructions
199007	SBC Disclosure	Form and Instruction	Modified	What the plan covers and what you play (Yes Answes)
199007	SBC Disclosure	Form and Instruction	Modified	What the plan covers and What you pay (No Answers)
199007	SBC Disclosure	Form	Modified	Uniform Glossary
199007	SBC Disclosure	Form and Instruction	Modified	Diabetes Narrative
199007	SBC Disclosure	Form and Instruction	Modified	Maternity Scenario

ICR Details

OMB Control No: 0938-1146	ICR Reference No: 201602-0938-012
Status: Historical Active	Previous ICR Reference No: 201506-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: 19325
Title: Summary of Benefits and Coverage and Uniform Glossary (CMS-10407)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/06/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/29/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2019	36 Months From Approved	10/31/2018
Responses	41,289,563	0	16,012,292
Time Burden (Hours)	325,333	0	322,731
Cost Burden (Dollars)	4,116,476	0	1,592,793

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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

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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

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 75488	12/02/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 9860	02/26/2016
Did the Agency receive public comments on this ICR? Yes

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

table that charts list of burden

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 ,   Uniform Glossary ,   What the plan covers and What you pay (No Answers) ,   What the plan covers and what you play (Yes Answes) ,   Group Instructions ,   Instructions - Individual ,   Completed SBC Sample ,   Blank Template ,   Coverage Examples - Narrative Foot Fracture ,   Coverage Examples Calculator ,   Coverage Examples Calculator ,   Having a baby ,   Managing diabetes ,   SBC Glossary Anchor ,   Simple Fracture

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ICR Summary of Burden

table that charts list 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	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

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 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.

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Annual Cost to Federal Government: $20,480

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

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Common Form ICR:  No

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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: 02/29/2016

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