HHS is looking to simplify health benefits information insurers provide to consumers in an effort to help people when they examine plans.
Under federal law, all group, individual and self-insured plans must include a summary of benefits and coverage for their members. These documents describe what the plans cover. They also explain cost-sharing functions, such as deductibles and copays, and special circumstances, such as whether a patient needs a referral to see a specialist.
Together, with the Departments of Labor and Treasury, HHS proposed rules Monday evening (PDF) to make the summaries more concise and comprehensible for consumers. The new, proposed summaries of benefits and coverage would be only two-and-a-half pages, double-sided (or five pages total), compared with the current four-page double-sided (or eight pages) maximum.
The summaries would be shorter because they would not need to include information about annual limits for essential health benefits or exclusions for pre-existing conditions, since the Patient Protection and Affordable Care Act eliminated those provisions.
The summaries also would include an extra coverage example, which the government said consumers find helpful when trying to understand their healthcare costs.
Federal law currently requires health plan benefits summaries to include two coverage examples: having a baby and managing type 2 diabetes. The examples show sample healthcare costs for hospital charges and prescription drugs. Under the proposed rules, health plan summaries would have a third example of a “simple fracture,” or if someone had to go to the emergency room for a broken foot.
An updated federal glossary (PDF) of healthcare terms also would accompany health plan policies. New terms like cost-sharing reductions would be included. Cost-sharing reductions are subsidies that help pay down deductibles and coinsurance for people who make between 100% and 250% of the federal poverty level and who choose a silver-level ACA exchange plan.
The federal government suggested several other policy changes, such as requiring health plans to disclose whether abortion services are covered and whether federal funding is included.
The goal of the proposed regulations is to help Americans “better understand their coverage options and make informed choices when shopping for a plan,” CMS Administrator Marilyn Tavenner said in a release.
Comments on the proposed rules are due by the end of February.
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