Regulators Issue Proposal on Health Benefits Education

Under the proposed rules, health insurers and group health plans will provide consumers with clear, consistent and comparable information about their health plan benefits and coverage. The new forms are scheduled to be available in 2012.  

Specifically, according to a DoL news release, the proposed regulations would ensure consumers have access to two forms to help them understand and evaluate their health insurance choices, including: 

• An easy to understand summary of benefits and coverage, and 
• A uniform glossary of terms commonly used in health insurance coverage, such as “deductible” and “co-pay.”  

All health plans and issuers would provide these materials to shoppers and enrollees upon request and before they buy coverage. Health plans and issuers must also provide notice at least 60 days before any significant modification is made in the plan or coverage during the plan or policy year. 

The summary of benefits and coverage would include a new, standardized health plan or policy comparison tool for consumers known as “coverage examples,” much like the nutrition facts label required for packaged foods. The coverage examples would illustrate what proportion of care expenses a health insurance policy or plan would cover for three common benefits scenarios — having a baby, treating breast cancer and managing diabetes.  Additional scenarios may be added in the future.    

The proposed regulations adopt recommendations submitted by the National Association of Insurance Commissioners and request comments on how the forms can be improved.   

More information about the proposed regulations is available at http://www.healthcare.gov/news/factsheets/labels08172011a.html. To view the proposed template for the summary of benefits and coverage, visit http://www.healthcare.gov/news/factsheets/labels08172011b.pdf.