Sep 27, 2012

U.S. health insurers begin to provide user-friendly plan guides

Must include summary of benefits and coverage in clearly worded, standardized format
By David Morgan and Caroline Humer
WASHINGTON (Reuters) — The Obama administration has begun requiring United States health insurers to provide user-friendly guides to patients that explain their benefits, aiming to make buying insurance nearly as easy as scanning packages of food for nutrition facts.

Under President Barack Obama's health-care reform law, employers and insurers must provide a summary of benefits and coverage in a clearly worded, standardized format that allows the private insurance market's 163 million beneficiaries to make side-by-side comparisons of plan offerings.

Consumers are also required to have access to a standardized glossary of insurance and medical terms. The rule takes effect just as insurers and employers prepare for annual enrolment periods, when employees select their coverage for 2013.

The benefit guides will also factor into the creation of new state-based health insurance markets due to begin offering subsidized, private coverage to moderate-income consumers in January 2014.

The Department of Health and Human Services released an eight-page sample benefits form to demonstrate how the actual summaries will outline everything from deductibles and out-of-pocket expenses to referrals and network providers.

The guides are also supposed to show what a plan covers for two common medical situations — new births and adult diabetes.

U.S. officials compared the summaries to the Nutrition Facts label required for packaged food sold in the United States.

The rule has been criticized by the insurance industry as a new administrative burden that will increase the cost of health-care coverage.

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