Sep 6

Written by: Besselman and Little
9/6/2011 9:55 AM 

The Obama administration proposed new rules recently that would require health insurance companies and employers to provide information to policyholders and employees describing health benefits, coverage and costs in plain English.

Kathleen Sebelius, the secretary of health and human services, said the new "summary of benefits and coverage" would make it easier for consumers to shop for insurance and compare plans.  The new forms, scheduled to be available next year, set disclosure standards for private health plans covering 180 million people.  The White House compared the new information to the "nutrition facts" labels found on many packaged foods.

As part of the new form, insurers and employers would have to itemize the costs that would be incurred by consumers needing certain services.  These "coverage examples" would show how insurers cover the cost of having a baby, treating breast cancer and managing diabetes.

In the summary of benefits coverage, insurers must answer questions like these:  "What is the premium? What is the overall deductible? Is there an out-of-pocket limit on my expenses? Is there an overall annual limit on what the insurer pays? Does this plan use a network of providers? Do I need a referral to see a specialist?" Insurers must also provide subscribers with a glossary offering standard, government-approved definitions of more than 40 terms commonly used in health insurance coverage, like "deductible" and "co-payment."

Under the new health care law, insurers and employers are supposed to provide the required information to consumers and employees by March 23, 2012.  Insurers and employers said they would probably need more time because the administration was late in issuing the proposed rule.

Source:  www.nytimes.com