New health benefits brochures are win-win for payers, consumers


I think it's safe to say that health insurance is a vital part of physical well-being. Taken a step further, the right insurance policy for the specific patient at the particular time helps ensure the best care is provided and healthcare dollars are not wasted. So, making a health plan selection is an important first step patients can take toward achieving good health. The way to make sure a patient has the right coverage is primarily by reading health insurance company brochures.

But here's the problem--these all-important brochures are hard to read. They usually have more than 100 pages, are written in tiny print and contain so much industry jargon that the average patient has a major headache after reading just a few pages.

"We're used to thinking about these terms in a very legal, technical way," says Maine Insurance Superintendent Mila Kofman. "But what insurance regulators or companies understand is, for the most part, not written in English for the average consumer."

Indeed. Research has already proven that health insurance policies are complex products, highly variable in their design, and key information about how coverage works is not always disclosed during marketing. So what's a consumer to do when he or she is shopping for health insurance plans? Or what's a patient to do when he or she is trying to determine whether a certain procedure or doctor is covered by the health plan?

The answer hopefully lies in a set of new guidelines just approved by the National Association of Insurance Commissioners that will require insurers to standardize these brochures and the information contained therein. The Department of Health and Human Services is expected to adopt and publish the recommendations in the near future.

"It's been kind of under-the-radar, but this is really a wonderful thing," says Ellen Andrews, executive director of the Connecticut Health Policy Project, a consumer advocacy group that offers a helpline to answer questions and assist residents in accessing healthcare. "We get calls all the time from people who think their policies cover certain things, and then find out they don't."

My hope is that health payers embrace this change. The guidelines include a four-page chart written in plain English that seems easily digestible. It also contains a glossary of terms to help decipher all the jargon. Research has already shown that consumers compare the prices of health insurance policies, but cannot always reliably tell if they are comparing like products.

The affordability of health insurance premiums cannot be considered independently of the adequacy of coverage health insurance provides. At a minimum, the difference in protection health insurance offers should be readily available for all to see.

Now, consumers should be able to better understand various insurance benefits so they can select the correct package for themselves and their family. I would even venture to guess that some people would be willing to spend more for a better, comprehensive policy--if they understand what they're paying for.

With the new standardized summary of benefits, insurers can clearly promote their products and maybe even eliminate potential conflict with customers due to misunderstandings in the future. That sounds like a win-win situation to me.

We may soon view these standardized health plan comparison tools like the ubiquitous nutrition label on foods products. We can't imagine a time when we couldn't quickly scan a simple four-page document to discern whether a health plan is the right fit. And maybe insurers won't want to remember back when valuable healthcare dollars were wasted because patients incorrectly chose a plan and were then forced to undergo a procedure that wasn't covered. - Dina

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