The long-term value of automating Summary of Benefits and Coverage (SBC) communications

On December 22, 2014, the Departments of Health and Human Services, Labor and the Treasury issued regulations proposing changes to the Summary of Benefits and Coverage (SBC) requirements and CMS templates to make them more user-friendly. The proposed changes wouldtake effect on or after Sept. 1, 2015.

The process to create the initial SBC in 2012 was a technical challenge for many health plan providers. With a fully automated document process not yet in place, many organizations met the 2012 requirements with a workaround approach that often meant building SBCs manually through Excel spreadsheets or engaging third-party providers to create the SBCs using similar time-consuming and often expensive methods.

Two challenges needed to be addressed – identifying source data and mapping the calculations to the SBC template fields. The sources needed for SBC calculations are typically contained in a variety of systems across an organization. As a result, it is often difficult to identify the location or owner of the particular data required.

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Department of Health and Human Services, Department of Labor, Department of Treasury, Elixir Technologies, SBC, Summary of Benefits and Coverage


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