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

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

The latest form for Summary of Benefits and Coverage and Uniform Glossary (CMS-10407) expires 2022-10-31 and can be found here.

SBC Disclosure

Federal Enterprise Architecture: Health - Health Care Services