Plain Language Rule Goes into Effect for Health Insurance Plans

Under the Affordable Care Act, insurance companies and employers are now required to provide consumers in the private health insurance market with a brief summary in plain language of what a health insurance policy or employer plan covers, called a summary of benefits and coverage. Health and Human Services Secretary Kathleen Sibelius says consumers will also have access to a uniform glossary that defines insurance and medical terms in standard, consumer-friendly terms.   Sibelius says the new tools empower consumers to make informed decisions about their health coverage options and to choose the plan that is best for them, their families, and their business.

The summary for consumers has information about covered health benefits, out-of-pocket costs and the network of providers. It also includes a comparison tool called “Coverage Examples” that is modeled after the nutrition-labeling feature for packaged food. Consumers can use it to compare options of what different health plans offer for two common medical conditions: managing Type 2 diabetes and having a baby.

The summary—which consumers will receive in writing and free of charge from their insurance company or employer—is available now for those in the individual market and will be available for those who enroll in group health plans during open-enrollment periods that begin after Sept. 23.