The "simple fracture" vignette includes the cost of an ER visit and some physical therapy.

The Centers for Medicare & Medicaid Services (CMS) has posted what it says the final version of the 2017 Summary of Benefits and Coverage (SBC) template.

CMS has made update choices that could make the SBCs more appealing to younger, healthier consumers.

See also: Health plan ‘carton labels’: Your last chance to comment on the new SBCs

Drafters of the Patient Protection and Affordable Care Act (PPACA) created the SBC notice, and the Uniform Glossary that’s supposed to come with the SBC, to create a “milk carton label” for health plans that employers, consumers, researchers and others could use to compare plans on an apples-to-apples basis.

The SBC concept has had strong bipartisan support, but, in practice, health insurers, consumer groups and others have agreed that the actual level of consumer use of the SBCs has been disappointing.

Critics have argued that the SBCs contain too little information about some topics, such as benefits for children, and benefits for people with catastrophic health problems, and that efforts to keep the SBCs short have backfired, by making the notices too crowded and too cryptic.

In the current SBC template, for example, a plan is supposed to give information about how it might handle a routine pregnancy, or a case of type 2 diabetes.

In the new 2017 SBC template, CMS has gone ahead with a previously announced proposal to add a scenario illustrating how a plan might cover emergency room care, rehabilitation therapy and other care for a broken bone.

Some interest groups had asked CMS to use the third scenario slot to illustrate how a plan might cover a catastrophic illness.

CMS also has gone ahead with a proposal to add an item summarizing the services a plan will cover before an enrollee meets the plan deductible. The current version of the SBC gives no information about coverage for pre-deductible services.

See also:

Feds aim benefits scenario at young invincibles

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

 

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