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Groups want kids on the health plan carton label

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The current version of the “milk carton label for health plans” says almost nothing about benefits for children, children’s health groups say.

A coalition of groups that includes the American Academy of Pediatrics, the American Academy of Family Physicians and March of Dimes is asking federal regulators to add more information about benefits for children to the Summary of Benefits and Coverage (SBC) template.

The SBC should list use of pediatric medical services as a “Common Medical Event,” quickly describe how a plan would cover that event, and include a link to a site that describes the plan’s pediatric coverage in more detail, the coalition says.

The Uniform Glossary that goes with an SBC should also describe how a plan covers both services and devices for children who need “habilitative services,” or help with gaining abilities they have never had, and the SBC itself should inform consumers about their rights to continue coverage during an ongoing course of treatment, the coalition says.

The coalition says that, today, all the SBC says about children’s benefits is that the Patient Protection and Affordable Care Act (PPACA) requires plans to provide some dental and vision benefits for children. The SBC says nothing out-of-pocket costs for children’s health care, or access to various tiers of providers, the coalition says.

A panel at the National Association of Insurance Commissioners (NAIC), the Consumer Information Subgroup, has posted a copy of the coalition’s comment letter on its section of the NAIC’s website.

PPACA drafters included the SBC and Uniform Glossary sections in an effort to give consumers and others a quick, easy, standardized way to compare health plans on an apples-to-apples basis.

The U.S. Department of Health and Human Services (HHS) and other federal departments are in the process of updating the SBC and glossary formats.

See also: Feds: 2016 SBC rules are coming ‘in the near future’


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