Health Law Requires Insurers to Use Plain Language in Describing Benefits, Coverage
Feb 15, 2012 -
Congressman Bill Owens praised the release of a new rule today under the health care reform law that requires insurance companies to eliminate technical or confusing language from their marketing materials that make it difficult for consumers to compare plans or understand exactly what they are buying. The new forms, which will be available beginning September 23, will be a critical resource for the roughly 150 million Americans with private health insurance today.
“This commonsense rule ensures that consumers will be better equipped to choose a plan that better fits them and their family,” Owens said. “Simplifying this information will ensure the purchase of appropriate coverage and provide peace of mind to New York families. Implementation of the health care law is critical if we want to get serious about improving outcomes and decreasing costs in the nation’s health care system.”
Specifically, these rules will ensure consumers have access to two key documents that will help them understand and evaluate their health insurance choices:
- A short, easy-to-understand Summary of Benefits and Coverage (SBC)
- A uniform glossary of terms commonly used in health insurance coverage, such as “deductible” and “co-payment.”
All health plans and insurers will provide an SBC to shoppers and enrollees at important points in the enrollment process, such upon application and at renewal. In the past, health insurers would only provide selective details on a policy before it was purchased.
“Health care reform has already saved seniors in New York millions on prescription medicine, insured more than 2.5 million young adults, and is on schedule to close the Medicare Part D ‘donut hole,” said Owens. “As the law continues to be implemented, it is critical that we move forward with key provisions that benefit millions of Americans while working to make changes and improvements where needed. I look forward to working with my colleagues on both sides of the aisle to move past the rhetoric and achieve this goal.”
A key feature of the SBC is a new, standardized plan comparison tool called “coverage examples,” similar to the Nutrition Facts label required for packaged foods. The coverage examples will illustrate sample medical situations and describe how much coverage the plan would provide in an event such as having a baby or managing Type II diabetes. These examples will help consumers understand and compare what they would have to pay under each plan they are considering.
To view the template for the summary of benefits and coverage, visit: http://cciio.cms.gov/programs/consumer/summaryandglossary/index.html
To view the Final Rule, visit: http://www.ofr.gov/OFRUpload/OFRData/2012-03230_PI.pdf
Other technical information is available at: http://cciio.cms.gov/
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