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Health plan 'carton labels': Your last chance to comment on the new SBCs

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Federal agencies are trying to rush a new “carton label” template for health plans out the door.

The Centers for Medicare & Medicaid Services (CMS) and the Employee Benefits Security Administration (EBSA) are putting the final version of the updated Summary of Benefits and Coverage (SBC) through a 30-day paperwork review process, according to a notice published today in the Federal Register.

See also: States push for longer benefits summaries

CMS, an arm of the U.S. Department of Health and Human Services (HHS), and EBSA, an arm of the U.S. Labor Department, are also putting the updated Uniform Glossary that goes with the SBC through a paperwork review process.

Comments are due March 28. The proposed templates and the current templates are available on the EBSA website. 

Paperwork review approvals usually last for three years.

The paperwork review notice lists Heather Raeburn as the CMS SBC contact person, Elizabeth Schumacher and Amber Rivers as the contact people for EBSA, and Karen Levin as the contact person for the Internal Revenue Service (IRS).

The Patient Protection and Affordable Care Act (PPACA) now requires issuers of major medical coverage to create SBCs, in an effort to create a simple plan summary document that consumers, employers, brokers and others can use to compare plans on an apples-to-apples basis.

The glossary is supposed to help consumers understand the SBC.

Critics have complained that, even though the SBC concept is popular, the current version of the SBC is less useful than it could be because it’s too hard to read and leaves out important information.

Insurers and state regulators at the National Association of Insurance Commissioners (NAIC) have argued that past drafts of the template were too short and failed to get consumers enough of the right information.

Many interest groups pushed for the SBC template to include more information relevant to their interests.

The current version of the SBC includes two scenarios meant to show what a plan’s benefits might work in real life. One involves “having a baby” and another involves “managing type 2 diabetes.”

CMS proposed, in December 2014, that a third scenario should illustrate what happens to a patient with “a simple fracture.” Some patient groups wanted CMS to illustrate how a plan would handle a more serious health problem, such as cancer.

The SBC version now going through paperwork review includes a third scenario, and the condition chosen is a simple fracture. Form developers have added individuals’ names to the scenarios: the SBC baby scenario in the new version of the form is called “Peg’s baby,” and the simple fracture is “Mia’s simple fracture.” The type 2 diabetes is called “Joe’s diabetes” (click on the image to enlarge).

The current version of the SBC shows, in a list of answers to “important questions,” whether the plan has an overall deductible, and whether it has other deductibles for specific services. The new version answers the question, “Are there services covered before you meet your deductible?”

The updated glossary adds definitions for relatively complicated, PPACA-related terms, such as “cost-sharing reduction,” and for basic insurance terms, such as “claim.” 

See also:

Feds aim benefits scenario at young invincibles

Plan ‘carton label’ changes could make pre-deductible benefits shine


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