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 SBC Template	Form	Modified	Available
SBC PRA 30 day supporting statement2_clean.docx	Supporting Statement A	Uploaded 2022-11-01	Repair queued
CMS-10407 Non-Substantive Change Request.pdf	Justification for No Material/Nonsubstantive Change	Uploaded 2019-11-27	Repair queued
Copy of CMS-10407-SBC PRA-2019 30-day Notice Period-Comments and Responses_OMB.xlsx	Supplementary Document	Uploaded 2019-10-24	Repair queued
Crosswalk of Changes.pdf	Supplementary Document	Uploaded 2019-10-22	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
201038	Deemed Compliance Reporting		Modified
199007	SBC Disclosure	Form	Modified	SBC Template
199007	SBC Disclosure	Other-Maternity Care Narrative	Modified

ICR Details

OMB Control No: 0938-1146	ICR Reference No: 202210-0938-011
Status: Historical Active	Previous ICR Reference No: 201911-0938-018
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
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: 05/30/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/01/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2026	36 Months From Approved	05/31/2023
Responses	24,211,595	0	41,805,055
Time Burden (Hours)	204,140	0	215,004
Cost Burden (Dollars)	10,494,154	0	4,180,463

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

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:
	87 FR 35783	06/13/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 64052	10/21/2022
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	SBC Template

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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	24,211,595	41,805,055	0	0	-17,593,460	0
Annual Time Burden (Hours)	204,140	215,004	0	0	-10,864	0
Annual Cost Burden (Dollars)	10,494,154	4,180,463	0	0	6,313,691	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: Based on the foregoing, the total hour burden reduced from 215,004 to 204,140 (a total reduction of 10,864 hours). The total hours are the sum of burden hours for issuers and TPAs to prepare the SBCs and coverage examples (28,462 hours), distribution of the SBCs (see item 13 below (175,102 hours), and deemed compliance (576 hours). The overall burden hour reduction is due to a decrease in the number of issuers associated with deemed compliance and a decrease in the number of notice of modifications issuers and plans are required to send.

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Annual Cost to Federal Government: $41,423

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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? No

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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: 11/01/2022

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