Health insurers may soon have to hand out short, standardized health plan guides. The insurers want to give out fewer guides later; consumer groups want want insurers to distribute more guides, and squeeze in more details.
Consumer representatives at the National Association of Insurance Commissioners (NAIC), Kansas City, Mo. — the people paid to speak up for consumers in NAIC proceedings — say, for example, that they would like to see the guides warn consumers about the possibility that they might have to pay for some hospital care out-of-pocket, even if they work hard to try to stay in-network.
The Employee Benefits Security Administration (EBSA) today posted 322 comments, including the comments from the NAIC consumer reps, on its website.
EBSA, an arm of the U.S. Department of Labor, has been working with the U.S. Department of Health and Human Services to develop Summary of Benefits and Coverage (SBC) requirements.
Regulators are developing the SBC requirements to implement Section 2715 of the Patient Protection and Affordable Care Act of 2010 (PPACA), which calls for the government to create a standardized health plan description document, to help consumers do a better job of shopping for coverage.
The concept is popular even with many Republicans who hate PPACA. Analysts at the Henry J. Kaiser Family Foundation, Menlo Park, Calif., recently surveyed Democrats and Republicans about PPACA and found when they asked about major PPACA provisions that the concept of requiring health insurers to provide standardized, easy-to-understand plan summaries had the support of 76% of the Republicans they polled.
Regulators want consumers to be able to use SBCs to compare plan provisions such as deductibles and co-payments, and also to help consumers compare what the total and itemized out-of-pocket costs might be for patients dealing with conditions such as pregnancy or diabetes
The proposed regulations would require group health plans and health insurers to start providing SBCs March 23, 2012.
Daniel Durham, an executive vice president at America’s Health Insurance Plans (AHIP), Washington, is asking regulators for an 18-month SBC deadline extension.
Regulators estimated implementing the regulations would cost private health insurers just $98 million altogether in 2011 and 2012 and $58 million in 2013.
AHIP believes that the first-year cost will be $188 million, that the cost of maintaining the SBCs will be $194 million per year, and that allowing an 18-month extension could reduce startup costs by 23%, Durham says.
AHIP also believes the current version of the form is suitable for coverage applicants and plan enrollees but not for shoppers, Durham says.
Plans would like to see regulators develop other, simpler forms aimed at individual, small group and large group shoppers, Durham says.
Janet Trautwein, the chief executive at the National Association of Health Underwriters (NAHU), Washington, participated in an SBC advisory group and says NAHU members support the SBC program goals.
Like the insurers, health agents and brokers would like to see regulators push back the date when insurers must provide SBCs 18 months, Trautwein says.
Trautwein notes that PPACA requires the regulators to have developed final SBC regulations by March 23, 2011. Given the fact that regulators have missed the PPACA SBC development guideline, it makes sense for the regulators to give employers and insurers more time to implement the SBC system, Trautwein says.