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Life Health > Health Insurance

States push for longer benefits summaries

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A group of state insurance regulators is pleading with federal agencies to let the standard “nutrition label for health plans” grow a little.

The Consumer Information Subgroup, part of the National Association of Insurance Commissioners (NAIC), is pushing for looser length limits in a letter about Summary of Benefits and Coverage (SBC) notice rules.

Federal agencies are trying to get a new, easier-to-understand SBC ready for 2017, and they agreed to let the NAIC draft a new SBC and put the revisions through a consumer testing process.

The Consumer Information Subgroup sent the agencies an SBC template, or blank SBC form, which takes up 2.5 sheets of standard U.S. typing paper in October. The federal agencies told the subgroup it thinks the Patient Protection and Affordable Care Act (PPACA) requires the template to fill up just two sheets of typing paper.

See also: Reality collides with PPACA benefits summary length limit

The subgroup came up with a shortened version of its template, but Angela Nelson, chair of the subgroup, has written to the agencies to say the subgroup hates the shortened version of the template.

“The requested truncated template has not been consumer tested and, outside of meeting an arbitrary and ill-founded interpretation of a statutory requirement, serves no other purpose,” Nelson writes in a memo addressed to PPACA implementers at the U.S. Department of Health and Human Services (HHS), the U.S. Labor Department and the U.S. Treasury Department.

“The subgroup believes the requested truncated template will be infinitely more confusing and less useful to consumers, and definitely runs counter to the letter and spirit of the ACA,” Nelson says.

PPACA requires each major medical plan to provide a standardized description of its benefits in a four-page SBC. The SBC creators wanted to help consumers, employers, brokers and others understand plan features and compare plans on an apples-to-apples basis.

In one section of the current version, for example, an issuer describes how a plan might cover a patient in two standard scenarios.

In another section, an issuer answers common questions about how the plan works.

Health insurers have supported the SBC program, but America’s Health Insurance Plans (AHIP) and NAIC panels have complained about the practical problems involved with making health plan features easy for consumers to understand and squeezing the descriptions into four pages. In practice, regulators have already decided that SBCs can take up both sides of four standard sheets of U.S. typing paper.

Insurers and consumer groups say the current SBCs leave out important information, such as basic information about benefits for children, or what services plans cover before enrollees reach their deductibles, and that the SBCs are too hard for many consumers to understand.

See also: 

Blues: Consumers no speak no PPACA-ese

Groups want kids on the health plan carton label

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