Plan 'carton label' changes could make pre-deductible benefits shine

State insurance regulators could help change the official health plan brochures in a way that would make consumers more aware of the benefits plans offer before enrollees meet their deductibles.

Members of the Consumer Information Subgroup, part of the National Association of Insurance Commissioners (NAIC), have included that idea in a preliminary draft of a proposed revision of the Summary of Benefits and Coverage (SBC) notice.

The SBC is supposed to be a clear, standardized “milk carton label” for health plans.

If the federal government adopts the NAIC subgroup’s current SBC revision proposal as is, every U.S. health plan would have to put answers to a list of “Important Questions” near the start of its SBC.

The first question would be, “What is the overall deductible?”

The second question would be, “Are there services covered before you meet your deductible?” The insurer would have to give a brief description of any pre-deductible covered services, and then explain, “Why This Matters.”

The version of the SBC now in use does not include a clear, standardized description of the benefits enrollees get before they meet their deductibles.

The insurer would then go on to answer questions such as, “Are there deductibles for other specific services?” and “What is not included in the out-of-pocket limit?”

Drafters of the Patient Protection and Affordable Care Act (PPACA) created the SBC in an effort to create clear, standardized plan benefits descriptions that consumers could use to compare plan benefits on an apples-to-apples basis.