This Just In, insurers Required to Speak
Plain English
This article originally appeared at Wendellpotter.com on February 13, 2012
HHS stiffens spine and
requires health insurance companies to clearly explain their policies.
All the attention paid
to the debacle about coverage for contraceptives over the past several days
obscured a broader, undisputed win for all consumers, including those who are
pregnant or about to be pregnant.
While the media was
obsessing about the contraceptives controversy, the Department of Health and
Human Services unveiled a final rule that even the Catholic bishops should
support. Starting this fall, insurers and employers that offer health care
benefits must provide us with more clearly written information about what their
benefit plans cover and how much of our own money we'll have to pay if we get
sick, injured or, yes, pregnant.
This is no small
matter. Rumors had been circulating in Washington over the past several months
that the administration would cave to the demands of the insurance industry's
trade organization that this requirement be gutted to the point of being
meaningless for most Americans. The rule requiring that this information be
written in plain English was part of the health care reform law.
The powerful insurers'
group, America's Health Insurance Plans (AHIP), reportedly was hard at work
early last week trying to persuade its friends in Congress, including some
Democrats, to flood the White House with calls urging that the new requirement
be postponed indefinitely and apply only to benefit plans sold outside of the
workplace. That would mean that the requirement, if ever implemented, would be
of value to only a small percentage of Americans.
So score one for
consumers, who don't often win these sorts of battles in the corridors of
power. Starting on Sept. 23, insurers and employers will have to provide much
more information than they do now in their marketing materials, and the
information will have to be displayed in a standard format to enable comparison
among plans. The companies will have to use plain language and 12-point type,
meaning the fine print will be a thing of the past. Imagine that.
One of the first
members of Congress to applaud the administration's display of backbone was
Sen. Jay Rockefeller (D-W.Va.), who has long championed greater transparency
and accountability in the health insurance business.
"Insurance companies
will no longer be allowed to hide behind loopholes and complex language to deny
customers the benefits they paid for and expect," he said. "People are going to
be able to demand more and more openness and clarity from the health insurance
coverage they are spending their hard-earned dollars on. They deserve to
be able to easily read and understand different policies so they can make the
best decision for their families."
AHIP, not
surprisingly, whined about the new rule, saying it would require "an almost
complete overhaul and redesign of how information must be provided to
consumers." You bet it will. And about time, too.
What insurers and
employers will have to do is provide us with a standardized summary of benefits
and coverage, including a "Coverage Facts" label for health care plans --
similar to the nutrition label on packaged foods we have grown accustomed to
seeing in grocery stores. So we will finally be able to see, for example, what
our deductibles and copayments will be if we choose one plan over another --
before we enroll and start paying premiums.
The summaries, which
can be no longer than eight pages, will also have to note if there are coverage
caps and whether referrals are needed to see specialists. They'll also have to
include two real-world examples -- like what and how much a particular plan will
cover if we have diabetes or if we get pregnant and how much we'll have to pay
out of our own pockets in both examples.
Consumer advocates had
asked the administration to include a third example: what's covered in the case
of cancer. While it will not be mandated this year, advocates are hopeful it
will be required soon, maybe even next year. Right now, the summaries aren't
required to detail how much premiums will be, but that, too, might be added in
the future.
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