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PPACA World dictionary expands

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A proposed update of the health plan summary of benefits and coverage (SBC) standards could include an update of the SBC’s little brother: the uniform glossary.

Drafters of the Patient Protection and Affordable Care Act (PPACA) tried to help consumers and employers shop for health plans on an apples-to-apples basis by requiring major medical plans to provide SBCs — “nutrition labels for health plans.”

PPACA drafters required the same plans to provide a standardized uniform glossary of health care and health insurance terms to help consumers understand and use their health coverage.

The version of the uniform glossary now in use takes up three pages and defines terms such as “premium,” “specialist” and “preferred provider.’ A diagram on a fourth page shows how deductibles, coinsurance percentages and out-of-pocket limits work.

A draft of a new version would include a page for the out-of-pocket cost diagram and five pages of definitions.

Officials at the U.S. Department of Health and Human Services (HHS) developed the glossary revision draft with help from officials at the Internal Revenue Service (IRS) and the Employee Benefits Security Administration (EBSA).

See also: 5 Labor Department PPACA audit insights.

Some of the proposed additions to the glossary may the result of regulator discoveries about how confused many consumers really are: The new revision includes definitions of basic terms such as “claim,” “diagnostic test” and “screening.”

Other additions may reflect areas in which consumers may be surprised to suddenly notice themselves having “skin in the game.” The glossary revision would add definitions for “formulary” and “specialty drug.” Those additions may be partly the result of consumers realizing that plans are trying to save money by discouraging use of expensive prescription medications.

Many of the other definitions have to do with the PPACA public exchange health plan subsidies and the penalty set to be imposed on many consumers who fail to own what the government believes to be adequate major medical coverage.

PPACA-related additions to the glossary revision draft include terms such as “cost-sharing reductions,” “individual responsibility,” “Marketplace,” “minimum value standard,” “minimum essential coverage,” and “minimum essential coverage exemption.”

See also: PPACA: Feds Try to Make Coverage Easier to Understand.


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