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Simplified Insurance Forms Will Help Consumers

Documents that give an overview of insurance benefits and healthcare costs coming soon

By January W. Payne | 04.13.2012
Originally Published April 2012

Consumers will soon have access to simplified documents explaining insurance benefits and healthcare costs, thanks to a provision of the Affordable Care Act that takes effect later this year.

Starting September 23, 2012, health insurers will be required to provide two forms that explain important details of benefits and coverage. The National Association of Insurance Commissioners, an organization created and run by chief insurance regulators from all 50 states, developed the prototypes for the forms.

Until now, consumers often did not have enough information to make informed decisions about which health insurance plan to choose, says Ruthlyn Noel, senior manager of public policy at the National Hemophilia Foundation (NHF). “For the first time, consumers have a tool to serve as a guide in assessing health insurance plans for themselves and their families,” she says. The availability of these new forms will give consumers the advantage of being able to sit down as a family, or as an individual, to compare coverage options and costs, Noel says.

The two forms—a Summary of Benefits and Coverage (SBC) and a uniform glossary of terms—will be provided at key points in the insurance enrollment process, such as when applying for coverage or renewing your policy.

The SBC will describe key plan features, such as insurance benefits, cost-sharing provisions and coverage limitations and exceptions, according to HealthCare.gov, a consumer Web site run by the U.S. Department of Health and Human Services. It will also include “coverage examples,” which will explain how much a plan will cover for two common scenarios—delivering a baby or managing type 2 diabetes.

The glossary will help consumers understand jargon often used in health plans. For example, it will define terms such as “out-of-network co-insurance” and “balance billing,” reports HealthCare.gov, which will also house the glossary online.

A 2011 study by New York-based Consumers Union (CU) found that the forms helped improve consumers’ understanding of the purpose and value of health insurance. They also made shopping for a health plan easier, according to an August 2011 CU news release.

“The success of health reform will depend to a large degree on making insurance options understandable to consumers and helping them to make informed choices,” said James R. Knickman, president and CEO of the New York State Health Foundation, in the CU news release. He said the new forms will help fulfill those purposes.

In addition, you should consider bleeding disorder-specific issues not addressed by these forms, Noel says. NHF’s Health Plan Comparison Guide is a useful tool. It suggests asking such questions as:

  • Is clotting factor covered by the plan? If so, is it a major medical or a pharmacy benefit?
  • Do you have a choice of more than one pharmacy provider?
  • Is your hemophilia treatment center in network?
  • Do you need a referral to see a specialist?

The guide also suggests creating a “personal health experience” sheet that lists which health services you’ve used in the last year. For example, you can tally how frequently you:

  • Visited your primary physician
  • Were seen by a specialist
  • Visited your HTC
  • Made a trip to an ER or urgent care center

But these are just some of the issues to keep in mind if you have a bleeding disorder and are considering health insurance options. Be sure to read the entire NHF Health Plan Comparison Guide before you choose a health plan.

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