We have gone over the terrors of insurance-speak many times here. If the whole thing weren’t so important, expensive and emotion-filled, the world of health insurance policies and their almost absurdly complicated explanations of benefits and exclusions, deductibles and co-pays, and lifetime limits and out-of-pocket maximums and all the rest would be funny. But be standing in the cold, impersonal lobby of a hospital emergency department at 2 a.m. trying to find someone to help you with your desperately sick baby and any humor is lost, entirely.
The Affordable Care Act is hoping to change this. Under recently published proposed rules, health insurers and group health plans are to provide policyholders with consistent, clear and comparable information about their health plans. More specifically, consumers are to have ready access to two particular forms that will help them understand what they are looking at as far as health insurance options are concerned, then help them evaluate their options:
- A Summary of Benefits and Coverage in easy-to-understand language.
- A uniform Glossary of Terms, those words commonly used when describing health insurance coverage, such as ‘co-pay’ and ‘deductible’.
- A more concise document, in plain language.
- Simple, consistent details about health plan benefits and coverage.
- Standardized language that lets a consumer compare different coverage options.
- Key features to be highlighted, such as cost-sharing provisions, exceptions and coverage limitations.
- ‘Coverage Examples’, a new and standardized health plan comparison tool – much like the nutrition labeling on packaged food.
- Simulated claims processing for each scenario so a consumer can see an illustration of the coverage he or she would get for the premium dollars spent per plan. A kind of ‘how it works’ explanation with examples.
- An insurance jargon de-coding tool, allowing apples-to-apples comparison shopping.
- Terms to be the same across all plans.
- All terms and language used to be easily accessed online and in print.
- Information when shopping for coverage. Traditionally, health insurers provide only their own marketing materials on a plan or policy before it is purchased. This gives consumers what is called a ‘selective understanding’ of what they are purchasing. Under the Act, consumers are to have all the critical information on the options and choices up front, before buying the coverage, so they can make better-informed decisions.
- Information when coverage changes. Those enrolled in a health plan must be given at least 60-days’ notice prior to the effective date of the change of any significant alterations in the terms of coverage as described in the Summary of Benefits and Coverage.
- Information on demand. A person enrolled in coverage, or a person shopping for coverage, can request a copy of the Summary of Benefits and Coverage at any time, and must receive it within 7 days. The uniform glossary is also to be made available upon request, as is a link to the plan or the insurance company providing the coverage.