“The idea is that the more informed the patient is, the better the decision that he or she can make,” CMS Administrator Dr. Donald Berwick said in media conference call. “Many times people will make decisions on coverage and not understand what they are going to get until they are sick.”
The standard policy information was required by the Patient Protection and Affordable Care Act.
The proposed rules would require an “easy to understand” summary of benefits and coverage and a uniform glossary of common insurance terms, according to an HHS description. The plan summary would include “coverage examples” to illustrate costs to patients under three common benefit scenarios: having a baby, treating breast cancer and managing diabetes. Regulators may add more scenarios in the future, according to federal officials.
The standard information aims to counter the practice of insurers releasing only “selective details” on their insurance plans before purchase that leaves consumers with an incomplete understanding of the specific benefits and limitations of the policy, according to an HHS release.
Dan Maguire, director of the Office of Health Plan Standards and Compliance Assistance at Labor, said the proposed rules may be phased in following insurer complaints that delays in their issuance should be matched by delays in implementation. Additionally, he noted, modifications to the proposed rules will likely include provisions to address the plans of self-insured companies.