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Life Health > Health Insurance > Your Practice

AHIP questions benefits summary math

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Carriers say state insurance regulators should help them cope with unworkable benefits summary requirements.

Colleen Gallaher, a senior vice president at America’s Health Insurance Plans, has included a plea for help with the federal Summary of Benefits and Coverage requirements and the federal Uniform Glossary requirement in a comment letter.

Gallaher sent the letter to the Regulatory Framework Task Force, an arm of the National Association of Insurance Commissioners, to weigh in on a draft Individual Market Health Insurance Coverage Model Regulation draft.

PPACA requires health insurers and employer health plans to help people compare plan on an “apples to apples” basis by distributing SBCs and health insurance term glossaries that take up no more than four double-sided sheets of paper.

The glossary is supposed to define terms such as “deductible” and “balance billing.”

Sticking to PPACA’s eight-page SBC-glossary limit is impossible, because the SBC templates takes up six pages and the glossary fills four pages, Gallaher said.

Federal regulators already have used “sub-regulatory guidance” and “compliance safe harbors” to help insurers and plans handle the fact that an SBC with a glossary can take up 12 pages or more, Gallaher said.

The NAIC should include the same relief, or state requirements we be “limited to the original unworkable federal requirements,” Gallaher said. “Health carriers shoud not be placed in a conflict of meeting the federal requirements but unable to meet states’ requirements.”

AHIP is asking the NAIC to replace detailed descriptions of the SBCs and the glossaries with more general phrases referring to rules set by the secretary of the U.S. Department of Health and Human Services.

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