Top leaders at the National Association of Insurance Commissioners (NAIC) and the body that represents all voting NAIC members are getting a final copy of a health insurance and medical term glossary that was developed to implement the Affordable Care Act.

The Executive Committee at the NAIC, Kansas City, Mo., and the plenary plan to consider the glossary and related standards for a summary of benefits and coverage explanations. The documents were created by subgroup at the NAIC’s Health Insurance and Managed Care Committee to implement Section 1001 of the Patient Protection and Affordable Care Act (PPACA), a component of the Affordable Care Act.

PPACA Section 1001, a consumer protection provision, authorizes the U.S. Secretary of Health and Human Services (HHS) to work with the NAIC to develop benefits explanation standards.

The committee adopted the standards in November 2010, and the NAIC approved sent the glossary and benefits explanation examples and sent them to HHS Secretary Kathleen Sebelius in December 2010.

The NAIC officials responsible for state implementation of NAIC-adopted models have included copies of the documents as attachments to an agenda for a join Executive Committee-plenary session. The NAIC hopes to hold the session March 29 at its upcoming spring meeting in Austin, Texas.

In the glossary, the NAIC defines “allowed amount,” for example, as, “Maximum amount on which payment is based for covered health care services. This may be called ‘eligible expense,’ ‘payment allowance’ or ‘negotiated rate.’ If your provider charges more than the allowed amount, you may have to pay the difference. (See Balance Billing.) “

The NAIC defines “balance billing” as, “When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you.”

- Allison Bell

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