Final rule released requiring insurers to use plain language in describing benefits, coverage

Posted on February 9, 2012 | No Comments
Filed under Centers for Medicare & Medicaid Services, Department of Health and Human Services, Department of Labor, Department of the Treasury, Employee Benefit Security Administration, Internal Revenue Service, Key Developments

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Today the Department of Health and Human Services, the Department of Treasury, and the Department of Labor released a final rule requiring insurers to use plain language in describing health plan benefits and coverage under the Affordable Care Act (ACA). The regulations mandate health insurers and group health plans to provide concise and comprehensible information about health plan benefits and coverage to Americans with private health coverage. The new rules will also facilitate easier plan comparison for individuals and employers. The new explanations, available on or soon after September 23, 2012, will be a critical resource for the roughly 150 million Americans with private health insurance. Specifically, these rules will ensure consumers have access to two key documents that will help them understand and evaluate their health insurance choices:

* A short, easy-to-understand Summary of Benefits and Coverage ( or “SBC”); and
* A uniform glossary of terms commonly used in health insurance coverage, such as “deductible” and “co-payment.”

Today’s rules finalize the proposed rules issued in August 2011. Click here for the summary of benefits and coverage final template and here for the glossary of health coverage and medical terms.

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Departments of Labor, HHS, and Treasury issue summary of benefits and coverage FAQs

May 17, 2012

The departments of Labor, Health and Human Services, and Treasury issued a set of 14 frequently asked questions (FAQs) and answers regarding implementation of the summary of benefits and coverage (SBC) provisions of the Affordable Care Act (ACA). Importantly in the FAQs, the departments announced that they would not take enforcement action against insurers in a number of circumstances for failure to fully comply with requirements that they provide a standardized SBC during the first year of applicability of the new rules. The departments issued a final rule in February requiring insurers to use plain language in describing benefits and coverage. With the final rule, the departments released a uniform glossary of terms. The guidance is the ninth set of FAQs posted regarding ACA compliance. This set of FAQs also addresses when plans and issuers can provide SBC electronically, circumstances that will trigger the requirement for an issuer to provide an SBC, and whether issuers are required to provide SBCs to group health plans or their sponsors that are shopping for coverage but have yet to submit an application.

Treasury, DOL, HHS issue new rules on providing insurance information to consumers

August 17, 2011

The Internal Revenue Service (IRS) of the U.S. Department of Treasury (Treasury), The Employee Benefits Security Administration (EBSA) of the U.S. Department of Labor (DOL), and the U.S. Department of Health and Human Services (HHS) have jointly-released two Notices of Proposed Rulemaking (NPRMs) covering the disclosure of the Summary of Benefits and Coverage and the Uniform Glossary to insurance consumers, aimed at providing clear, consistent, and comparable information about their health plan. The rules apply to group health plans and health insurance coverage in the group and individual markets under the Affordable Care Act (ACA), and include not only what must be disclosed to consumers, but also examples of the templates on which the information will be disclosed.

Update: Final Rule on Summary of Benefits and Uniform Glossary of Terms

March 9, 2012

The Affordable Care Act included a number of insurance market reforms designed to make health insurance more affordable and available. During consideration of the ACA, one criticism of the private insurance market was that the lack of standardization in descriptions of health insurance policies available made shopping for coverage both difficult and time consuming. The ACA included provisions designed to assist consumers in better understanding their health insurance coverage, and to assist in comparing their insurance policy with other available options. Among those provisions are requirements for plans offered in both the group and individual insurance markets to provide a summary of benefits and coverage and a uniform glossary of terms commonly used in health insurance policies.

Update: Racial and Ethnic Disparities in Health and Health Care

December 1, 2011

This post serves as an Implementation Update to our previous Implementation Brief on racial and ethnic disparities, originally posted April 15, 2010. The Update reflects changes made by HHS in their recently-released health survey standards.

Proposed Disclosure Rules Regarding Summary of Benefits and Coverage

September 30, 2011

The Affordable Care Act (ACA) included a new requirement that health plans in the group and individual markets disclose plan information to consumers in a standardized, accessible format in order to facilitate comparison of plans and improve understanding of plan terms. On August 22, 2011, several federal agencies jointly issued a notice of proposed rulemaking (NPRM) setting forth proposed disclosure requirements, including templates for the disclosures. Comments are due on October 21, 2011.

Racial and Ethnic Disparities in Health and Health Care

April 15, 2010

Requires federally conducted or supported health programs to collect and report data related to race, ethnicity, and other indicators sufficient to generate statistically reliable estimates of health disparities.