Standardized forms intended to ease the process of shopping for health insurance were released Wednesday by the Obama administration.
The Affordable Care Act requires insurance companies to adopt the forms, which use simple language to explain a plan’s benefits and coverage and are designed to make it easier for consumers to comparison-shop.
• To view the forms, click here (PDF file)
By March 2012, insurers must begin providing for consumers summary sheets no longer than four double-sided pages, that lay out in a question-and-answer format information on premiums, deductibles, out-of-pocket expenses and other elements. The forms will explain how much consumers can expect to pay for common medical services and show how the plan might cover medical care in three scenarios having a baby, treating breast cancer and managing diabetes.
The summary sheets must include a glossary that defines terms like “coinsurance” and “co-payments,” and direct consumers in how they can file grievances and appeals.
HHS Secretary Kathleen Sebelius adopted the forms as they were designed by the National Association of Insurance Commissioners (NAIC), and insurers must use them for new plans or existing plans that roll over beginning next March.
“Today, many consumers don’t have easy access to information in plain English to help them understand the differences in the coverage and benefits provided by different health plans,” Mrs. Sebelius said. “Thanks to the Affordable Care Act, that will change.”
Surveys have shown that a majority of Americans have difficulty understanding and selecting health insurance plans owing to their complexity and confusing explanations. The standardized forms have been compared to food nutrition labels because they allow consumers to see a plan’s value.
Under the new rule, consumers will be legally entitled to receive the summary forms upon requesting information about a plan and before putting any money down, officials said. For those with employer-based coverage, they’ll most typically be accessed during open-enrollment seasons.
“If you’re asking for information about coverage, they have to give you this summary of benefits and coverage,” said Amy Turner, a senior adviser for the Department of Labor. “They couldn’t give you a bunch of really long documents.”
A leading industry group is contending that in some cases, insurers would be required to create many different versions of the form. Robert Zirkelbach, spokesman for America’s Health Insurance Plans, didn’t deny the standardized form will bring some benefits, but said they must be weighed against more administrative burdens on insurers that could turn into higher costs for consumers.
“For example, since most large employers customize the benefit packages they provide to their employees, some health plans could be required to create tens of thousands of different versions of this new document — which would add administrative costs without meaningfully helping employees,” Mr. Zirkelbach said.
But Monica Lindeen, insurance commissioner for Montana and a committee vice chairman for the NAIC, questioned that claim, saying insurers are used to producing lots of information.
“The insurance companies actually produce all sorts of information already for their customers, and they also go through the process of changing forms, so I’m not really sure about that criticism,” she said.
• Paige Winfield Cunningham can be reached at pcunningham@washingtontimes.com.
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