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Health Insurers Must Provide “Plain English” Summaries of Benefits, Coverage

Those seeking health insurance will soon have clear, understandable and straightforward information on what health plans will cover, what limitations or conditions will apply, and what they will pay for services, according to final regulations published by the HHS.

Under the rule, health insurers must provide consumers with "plain English" summary information about their health plan benefits and coverage. The new forms, which will be available in September, target the roughly 150 million Americans with private health insurance today.

Specifically, these rules will ensure consumers have access to two key documents that will help them understand and evaluate their health insurance choices:

  • A Summary of Benefits and Coverage ( or "SBC").
  • A uniform glossary of terms commonly used in health insurance coverage.

All health plans and insurers will provide an SBC to shoppers and enrollees during the enrollment process, such as upon application and at renewal. In the past, health insurers would only provide selective details on a policy before it was purchased.

A key feature of the SBC is a new, standardized plan comparison tool called "coverage examples," providing sample medical situations and describing how much coverage the plan would provide in an event such as having a baby (normal delivery) or managing Type II diabetes (routine maintenance, well-controlled) These examples will help consumers understand and compare what they would have to pay under each plan they are considering.

Today’s rules, published jointly by HHS and the Labor and Treasury Department, finalize the proposed rules issued in August 2011. Click here to view the template for the summary of benefits and coverage.

Click here to view the final rule.

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Source: HHS, February 9, 2012


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Health Insurance Exchanges: Strategies and Stakeholders is available from the Healthcare Intelligence Network for $89 by visiting our Online Bookstore or by calling toll-free (888) 446-3530.



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IMPORTANT NOTICE: This information is designed to provide accurate and authoritative information on the business of healthcare. It is distributed with the understanding that Healthcare Intelligence Network is not engaged in rendering legal advice. If legal advice is required, the services of a competent professional should be retained.



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