Obama Administration Releases New Rules on Explanation of Benefits under Health Reform

by Rebecca Farley on August 17, 2011

summary of insurance coverageOn August 17, the Departments of Health and Human Services (HHS), Labor, and the Treasury proposed a new rule under the Affordable Care Act that will enable insurance policyholders to easily understand their benefits and covered services. The rule is designed to address a lack of information about health benefits among consumers, who often have a difficult time wading through explanations of benefits that are couched in highly technical language that is not easily comparable from plan to plan.

The proposed rule will ensure consumers have access to two forms to help them understand and evaluate their health insurance choices: an easy to understand Summary of Benefits and Coverage, and a uniform glossary of terms commonly used in health insurance coverage, such as “deductible” and “co-pay.” The Summary of Benefits and Coverage will include a plan comparison tool for consumers known as “Coverage Examples,” which illustrates what proportion of care expenses a health insurance policy or plan would cover for three common benefits scenarios: having a baby, treating breast cancer, and managing diabetes. The two forms will become available for use in 2012.

More information about the proposed regulation is available on healthcare.gov. To view the proposed template for the Summary of Benefits and Coverage, click here. The text of the proposed rule will be available here until Aug. 22; at that time, it will be published in the Federal Register.


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