Terrific News For The Rest of Us: HHS News Release

It was announced yesterday that a sensible and important part of the health reform law will take effect after all.  Some weeks ago, we reported that there was real concern following President Obama’s State of the Union address that, given the present political climate and anxiety about too much government regulation, certain consumer-friendly reforms would not be put into effect as planned.

We were not wrong to worry – but now, thank goodness, the right thing has been done.  Long story short, yesterday’s statement means they’ve finalized and approved the proposed rules first issued last August.  According to the press release, ‘the final rules aim to ensure strong consumer information while minimizing paperwork and cost‘.  Why anyone ever questioned the value of this is beyond us.

What’s all the fuss about?  Marketing materials, for the most part.  According to the Health and Human Services update

The marketing material that insurers use can sometimes make it difficult for consumers to understand exactly what they are buying.  The new rules, published jointly by the Departments of Health and Human Services, Labor and Treasury, require health insurers and group health plans to provide concise and comprehensible information about health plan benefits and coverage to the millions of Americans with private health coverage.  The new rules will also make it easier for people and employers to directly compare one plan to another.

And there’s more:

‘All consumers, for the first time, will really be able to clearly comprehend the sometimes confusing language insurance plans often use in marketing,’ said HHS Secretary Kathleen Sebelius.  ‘This will give them a new edge in deciding which plan will best suit their needs and those of their families or employees’.

Here’s how it will help:

Under the rule announced today, health insurers must provide consumers with clear, consistent and comparable summary information about their health plan benefits and coverage.  The new explanations, which will be available beginning, or soon after, September 23, 2012, will be a critical resource for the roughly 150 million Americans with private health insurance today.

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 (or ‘SBC’); and
  • 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 as upon application and at renewal.  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 (normal delivery) or managing Type II diabetes (routine maintenance, well-controlled).  These examples will help consumers understand and compare what they would have to pay under each plan they are considering.

This is a win for everyone.  There are parts of the Affordable Care Act that are more than a little controversial, but this isn’t one of them.   These rules go along with the disclosure we talked about with second victim syndrome over the past few days: disclosure that heals, reduces harm and helps support an inclusive and ethical health care system that actually works.


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