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Nov 4 2011 11:46AM
Make insurance understandable

Shopping for health insurance is a task that most of us dread — more than paying our taxes or going to the gym, according to one survey. A new health insurance disclosure form, called the Summary of Benefits and Coverage, could help change that. But some insurer and employer groups are opposing this. The new form, part of a federal rule now being finalized by the Department of Health and Human Services, would standardize how consumers view health plan information — like premiums and deductibles. It would also include a new feature, called Coverage Examples, that illustrates complicated health plan provisions using hypothetical medical scenarios — much like nutritional labels on packaged food.Consumers value the new form, according to the consumer testing sponsored by Consumers Union, the nonprofit publisher of Consumer Reports. They particularly liked the Coverage Examples, which they said helped illuminate the cost of medical care and the portion covered by health insurance. Unfortunately, groups representing the health insurance industry and employers want to undermine this new consumer information. In their comments on the proposed HHS rule, some groups are downplaying the value of the new forms to consumers or urging HHS to drop Coverage Examples entirely. The Blue Cross and Blue Shield Association said the proposed forms will not add significant value to the decision-making and/or purchasing process.America s Health Insurance Plans said the new consumer information would add significant administrative costs without providing meaningful help to employees. It is not surprising to hear these organizations worry about the cost of producing these forms. But to claim that the new forms add little value is preposterous.Insurers participated in the stakeholder group that developed the prototype forms. They also sponsored two of the four studies testing consumer responses to the forms. This insurer-sponsored testing found the form is highly valued by consumers as a way to understand and compare coverage. Consumers showed universal support for a simplified, standardized format for summarizing plans across the industry. The industry s own testing found the Coverage Examples helpful to a majority of participants. Consumers strongly encouraged the use of the examples and immediately comprehended that they were examples only — not the cost of their own potential treatment. Groups representing employers want to continue using their current forms — as long as they include most of the required elements in the Summary of Benefits and Coverage, and they oppose the Coverage Examples outright. They argue that existing information materials are effective in helping employees make well-informed decisions.Again, evidence suggests otherwise. An analysis by the Employee Benefit Research Institute found that employer plans current descriptions require fundamental improvements to be fully understood. These lengthy documents use technical jargon that the average participant cannot figure out. Even expert readers had difficulty identifying important information.Other research has revealed that employer forms offer an inadequate picture of what is covered. A survey of insured cancer patients found that, among those with employer-sponsored health benefits, 12 percent were surprised to find out their health plan would not pay anything for care they thought was covered, and 24 percent reported their plan paid less than they expected. These new health insurance disclosures are important. They provide critical help for the 180 million Americans with private health insurance. In finalizing their rule, HHS must ignore insurers and employers mischaracterization of the forms — and instead rely on the evidence that demonstrates tremendous consumer benefit from a uniform, consumer-friendly health insurance disclosure form.
 
 
 
 
 
 
 
 
 
     
 
     
 
 
 
 
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