2.22.2012 | by:
I read food labels. Yes, I’m that person who blocks the grocery aisle (or at least part of the aisle) as I compare ingredients and nutrition content. What I pay closest attention to has changed over the years—first it was fat, then fiber and sodium, and now sugar—but if it’s got a package, I’m looking at the label.
That’s why the release of the final rules of Section 2715 of the Affordable Care Act (ACA) caught my attention. Section 2715, a provision in the ACA, will require all health insurers and group health plans to provide applicants and enrollees a uniform summary of benefits and coverage that includes at least two “coverage examples” (having a baby and diabetes treatment) to illustrate a patient’s share of costs for care. Beginning in September, plans must also make available a uniform glossary of health coverage and medical terms, such as balance billing and habilitation services.* Put another way, plans have to describe in plain language what a policy covers, what’s excluded, and information about deductibles, co-insurance and copayments. Sort of like a nutrition label for health insurance.
Since 2010, my family has enrolled in four different health plans through our employer-sponsored coverage due to carrier (and job) changes. Fortunately, our employers provided helpful summaries for some of the plans but even I struggled to understand some of the options. And I once worked in a managed care department for an academic medical center and considered myself savvy in the ways of the health insurance world. What about everyone else, including the estimated 328,000 Coloradans who will be newly insured in the private insurance market in 2014 under health reform?
In Colorado we have resources to understand insurance coverage—including the Division of Insurance’s website. And in 2013, the Colorado Health Benefit Exchange will help individuals and small businesses shop for and buy health insurance. Ideally, the Exchange will line up all those health insurance nutrition labels that are coming as a result of Section 2715 so that we will better understand the coverage that we are purchasing.
Some are cheering Section 2715, saying it creates greater transparency and allows consumers to make informed decisions when purchasing coverage. Others argue that the rules add another layer of bureaucracy and administration into the health insurance system, with the potential to increase costs for employers and consumers. And cost is an important consideration, with 85% of uninsured Coloradans citing high cost as the major reason for not having health insurance.
What do you think?
* As an aside, if you’re curious about habilitation services and can’t wait until 2013 open enrollment, the glossary defines them as “services that help a person keep, learn or improve skills and functioning for daily living. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of inpatient and/or outpatient settings.” Balance billing is when a provider outside of your network bills you for the difference between the provider’s charge and the allowed amount.
Sara Schmitt is the director of community health policy at CHI.