If you or a loved one has ever been tripped up by “the fine
print” in your health insurance policy, you will be pleased by a provision of
the Affordable Care Act that took effect this week. As of September 24, 2012, private health
insurance plans provided by employers or that individuals purchase on their own
must use standardized charts and explanations clearly laying out what they do
and do not cover, as well as other important things to know about how the plan
works.
The ‘Summary of Benefits & Coverage’ requirements also
include a standardized glossary of commonly-used coverage and medical terms, as
well as at least two ‘coverage facts labels.’
Modeled after the ‘nutrition facts label’ required on most packaged
foods, the coverage facts labels are sample illustrations of costs and coverage
for common coverage scenarios, like diabetes treatment or maternity coverage. These sample illustrations are provided so consumers
can get a sense of what their real costs could
be.
Note that not every group health plan is required to provide
the forms. Medicare, Medicaid and
so-called ‘grandfathered’ private health plans (plans in place just as they
were when the Affordable Care Act was signed into law) are not required to
provide the Summary of Benefits & Coverage charts.
Studies tell us that the public is eager for help making
sense of health insurance. In a 2011
nationwide public opinion, participants ranked the requirement that insurers
and health plans provide easy-to-understand summaries of their coverage above
all other provisions of the Affordable Care Act. Consumers Union, publishers of Consumer Reports magazine, helped
develop the forms and tested them out in focus groups. They hope to get more
feedback as people start seeing them during their health plan’s open enrollment
season, or when individuals go shopping for health coverage on their own. That’s when health plans must provide the
charts customized to plan(s) being described.
You can check out sample versions of the charts, along with Consumer
Union’s notes on what to pay most attention to here.
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