iToday, the U.S. Department of Health and Human Services (HHS), Department of Labor, and Department of the Treasury (the Departments) proposed a new rule requiring health insurers and group health plans to provide consumers with two standardized forms:
- An easy to understand Summary of Benefits and Coverage
- A uniform glossary of terms commonly used in health insurance coverage
The forms were developed through a process with the National Association of Insurance Commissioners (NAIC) and interested stakeholders, including health insurers, health care professionals, patient advocates, and consumer advocacy organizations. The proposed rule adopts the NAIC’s recommendations.
The Summary of Benefits and Coverage form includes a standardized policy comparison tool called “Coverage Examples,” similar to nutrition labels on packaged foods. The Coverage Examples will note what portion of care expenses a policy or plan would cover for three benefit scenarios – having a baby, treating breast cancer, and managing diabetes. HHS may add additional benefit scenarios to the form in the future. The glossary of terms applicable to all insurance plans and policies will be distributed by insurers and also made available to consumers via HHS’ healthcare website.
The new forms are scheduled for use as of March 23, 2012, when insurers must provide the forms to consumers upon request and before coverage purchases. Under the proposed rule, health plans and insurers must also provide at least 60 days notice before making significant modifications to plan or policy coverage during the policy year.
The proposed rule implements provisions of the Affordable Care Act that ensure access to forms that help consumers understand and evaluate health insurance choices. Additional information regarding the proposed rule is available via an HHS fact sheet. Once the rule is published in the Federal Register, the Departments will accept public comment on the forms for 60 days following the date of publication.
