Proposed Regulations to Make Health Insurance Shopping Easier for Consumers

PUTTING PEOPLE FIRST

As part of the Patient Protection and Affordable Care Act (PPACA) the Department of Labor and the Department of Health and Human Services has proposed some new regulations centered around clarifying health plan benefits and coverage for consumers. 

Many consumers feel overwhelmed when trying to decide which plan to take because the information is somewhat sophisticated.  In an effort to simplify the information, a “uniform summary of coverage” represented by: 1) a Summary of Benefits and Coverage form, as well as;  2) a glossary of universal health insurance terms, has been proposed.   These two documents will provide consumers with clear-cut information that is easily used for comparison purposes, thus allowing them to better understand and evaluate their health insurance options.

The Summary of Benefits and Coverage will be available to the consumer within seven days of their request, while shopping for coverage, or during the open enrollment period at each new plan year.  This document will encompass the key features of the plan including benefits covered, limitations and exceptions as well as cost-sharing provisions.  The Center for Consumer Information and Insurance Oversight (CCIIO) will include standardized information for circumstances like having a baby, treating breast cancer and managing diabetes so that consumers can see an illustration of what the plan would look like under each scenario.  This summary will allow consumers to better understand what they are getting in return for the premium payments they are making.

The second document proposed is a glossary of terms frequently used within the universal health insurance industry.  This glossary will be available to consumers upon request and will also be found at www.healthcare.gov and www.dol.gov/ebsa/healthreform

Click this link to see the Summary of Benefits and Coverage Template http://www.dol.gov/ebsa/pdf/SBCtemplate.pdf .

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