HHS issues final rule for payers' summary of benefits

Insurers must provide consumers with standardized, easy-to-read summary of benefits and coverage documents beginning Sept. 23 or risk penalties up to $1,000 for each individual enrolled in a plan.

A final rule released Thursday by the U.S. Department of Health & Human Services sets out requirements for the four-page, 12-point font document, which the agency compared to the Nutrition Facts labels on packaged foods. It also requires that insurers provide a glossary of terms commonly used in health insurance coverage, including deductible and copayment, Kaiser Health News reported.

"All consumers, for the first time, will really be able to clearly comprehend the sometimes confusing language insurance plans often use in marketing," said HHS Secretary Kathleen Sebelius.

HHS officials added that the standardized forms mean insurers "can't bury in fine print" any substandard coverage, and consumers can make "apples-to-apples" comparisons of various health plans, reported The Hill's Healthwatch.

The biggest change from the proposed rule published last August is that insurers no longer must include premium costs in the standardized forms. The final rule also dropped a required section outlining typical breast cancer costs. That portion of the comparison tool called "coverage examples" was too complicated because breast cancer treatment varies greatly from patient to patient, Bloomberg reported.

"There was concern expressed that breast cancer was a more complicated treatment scenario, that the treatment scenario wasn't always standardized across issuers," Steve Larsen, director of the HHS Center for Consumer Information and Insurance Oversight, said on a call announcing the final rule. However, "we didn't take this off because it happens to be more expensive," he clarified. "It just needed more work."

Insurers still must provide examples for treatment costs related to Type 2 diabetes and a normal baby delivery. HHS may add up to six other required examples in the future.

To learn more:
- read the HHS final rule (.pdf)
- view the summary of benefits template (.pdf)
- read the Kaiser Health News article
- see the Bloomberg article
- check out The Hill's Healthwatch article