The Affordable Care Act requires that all health insurers provide concise and understandable information about their plans and benefits. It’s an all-too-familiar scenario – reading over your health plan three times and still not understanding what’s covered. Well, effective September 23, 2012, all that is going to be a thing of the past.
Patients will have a right to the following two key documents to help them understand and compare their health insurance options:
Summary of Benefits and Coverage (SBC)
A clear, concise, and user-friendly document provided by health insurance companies and group health plans that plainly spells out all of your benefits and coverage. The SBC will be readily available when consumers need it the most: when shopping for a plan, at the start of each plan year, and upon request at any time.
The SBC will have “coverage examples” with a signature look, too, modeled after the Nutrition Facts label on packaged foods. According to healthcare.gov, the coverage examples “will illustrate, for comparison purposes, what proportion of the cost of care a health insurance policy or plan would cover for a sample patient for two common medical situations—having a baby and managing type 2 diabetes. Additional scenarios will be added in the future as feedback is gathered from consumers.”
Uniform Glossary of Health-Coverage and Medical Terms
The term “uniform” is key here. The glossary will have consistent definitions across the board for health coverage and medical terms that are commonly used such as “co-insurance” and “deductible.” For even easier access, the Departments of Health and Human Services and Labor will also post the glossary on their website.