Would you buy a car without knowing its features or gas mileage?
Then why do we purchase health insurance that way?
"Health insurance is one of the most expensive things we buy where you're essentially supposed to buy it without understanding what you've just purchased," says Lynn Quincy, senior policy analyst for Consumers Union, the publisher of Consumer Reports.
"It's unfair not to provide uniform, understandable information about a product that is this expensive and has enormous financial and health consequences for families," Quincy says.
Cutting through the gobbledygook
To date, health insurers have been free to present information about their policies any way they choose, making it difficult for consumers to decipher plan descriptions buried deep in industry jargon and legalese. This makes it nearly impossible to compare health plans.
"Some plans are 100 pages long and were really written by lawyers to protect the insurance company rather than to inform the consumer," says Tim Jost, health law scholar and professor of law at Washington and Lee University. "They're basically useless to consumers."
But a new phase of the health care reform law attempts to correct the confusion by requiring health insurance companies to make available a uniform "Summary of Benefits and Coverage," or SBC, a reader-friendly disclosure of their individual or group policy details written in everyday language.
Insurers will be required to provide SBCs to: new applicants; current customers, whenever coverage is renewed or changed; and anyone seeking the information on demand. It will be available in English, Spanish, Chinese, Tagalog and Navajo.
Like a 'yogurt label' for health plans
Jost and Quincy were two of many experts who helped design what some have termed the "nutrition facts" or "yogurt label" for health insurance. The design team, led by the National Association of Insurance Commissioners, included the federal departments of Health and Human Services, Labor and Treasury, as well as health insurers, health care professionals, consumer and patient advocates, and linguists.
Their task: Create a short, easy-to-understand health benefits summary and an accompanying standard glossary of terms. The goal was to provide clear, consistent and comparable information that everyone can use to shop for health insurance.
The resulting glossary covers commonly used insurance lingo, from "allowed amount" (the maximum an insurer will pay for a covered health service) to "urgent care" (care that a reasonable person would seek right away, though not severe enough to require a trip to the emergency room).
The Summary of Benefits and Coverage, which can span no more than four double-sided pages, will contain most of the details every shopper wants to know about a health plan: its estimated deductibles; limit on your out-of-pocket costs; annual coverage limit; copayments; in-network versus out-of-network costs; and limitations and exceptions for routine office visits, ER visits, outpatient surgery, hospital stays, mental health/substance abuse counseling and prenatal/postnatal care.
Having all that information will give consumers "a new edge in deciding which plan will best suit their needs and those of their families or employees," says Health and Human Services Secretary Kathleen Sebelius.
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