Insurers would be required to provide consumers with simple, standardized information regarding health policies under proposed regulations announced by the federal departments of Health and Human Services, Labor, and Treasury.
Under the regulations, insurers would be required to provide an outline of benefits, expenses, premiums, and other coverage details on no more than four double-sided pages. The document – called a Summary of Benefits and Coverage – must include examples of how coverage would apply in real-life situations, such as labor and delivery and diabetes management. Any changes in coverage will require 60-day notice.
“Instead of trying to decipher dozens of pages of just dense text, to just guess how a plan will cover your care, now it will be clearly stated in plain English,” said Dr. Donald Berwick, administrator of the Centers for Medicare and Medicaid Services.
Officials said the standardized process would make it easier for consumers as well as companies looking to provide insurance for employees to compare plans, making way for a more competitive market. “If an insurer's plan offers a subpar coverage in some area, they won't be able to hide that in dozens of pages of text. They'll have to come right out and say it,” Dr. Berwick said.
The standardized forms underwent months of testing through the Consumers Union, which showed that the forms helped purchasers compare their insurance options, said Lynn Quincy, senior policy analyst for Consumers Union. “Seeing the total amount they had to pay made it much easier to understand how much coverage they were getting from the health plan,” she said.
The proposed regulations include recommendations from the National Association of Insurance Commissioners. Comments can be made at www.regulations.gov
A plan with 'subpar coverage in some area … won't be able to hide that in dozens of pages of text.'
Source DR. BERWICK