Reg­u­la­tion frus­tra­tion

In­sur­ers seek time on sim­pli­fied plan sum­maries

Modern Healthcare - - THE WEEK IN HEALTHCARE - Rich Daly

Later this year, health plans will be re­quired for the first time to pro­vide con­sumers with na­tion­ally stan­dard­ized de­scrip­tions of the ben­e­fits and cov­er­age they pro­vide. The in­dus­try’s largest trade group said it will be no easy task.

The dis­clo­sures, re­quired un­der the Pa­tient Pro­tec­tion and Af­ford­able Care Act, are out­lined in final reg­u­la­tions the Obama ad­min­is­tra­tion is­sued last week. The rule is in­tended to give con­sumers plain-lan­guage and com­pa­ra­ble ex­pla­na­tions as they choose among plans. HHS of­fi­cials said health in­sur­ers have used mar­ket­ing ma­te­ri­als to ob­fus­cate im­por­tant de­tails.

The reg­u­la­tions pre­scribe a sum­mary of ben­e­fits and cov­er­age, as well as a glos­sary defin­ing the terms used in the de­scrip­tion, for plans that be­gin af­ter Sept. 22. “Mar­kets work best when peo­ple have the in­forma- tion they need to make in­formed de­ci­sions,” Marilyn Taven­ner, act­ing ad­min­is­tra­tor of the CMS, said in a call with re­porters.

The new rules, pub­lished jointly by HHS and the La­bor and Trea­sury de­part­ments, also re­quire each plan to il­lus­trate its costs of cov­er­age in the cases of child­birth and treat­ment for di­a­betes.

Karen Ig­nagni, pres­i­dent and CEO of Amer­ica’s Health In­sur­ance Plans, said in a state­ment that the ad­min­is­tra­tion made some im­prove­ments but that health plans need more time and flex­i­bil­ity.

“The final rule re­quires an al­most com­plete over­haul and re­design of how in­for­ma­tion must be pro­vided to con­sumers,” Ig­nagni said. She added that the short time frame “cre­ates sig­nif­i­cant ad­min­is­tra­tive chal­lenges that will in­crease costs and re­sult in du­pli­ca­tion be­cause many plans are al­ready de­vel­op­ing ma­te­ri­als for em­ploy­ers whose poli­cies take ef­fect Oct. 1, 2012.” AHIP es­ti­mates that com­ply­ing with the rule will cost in­sur­ers $188 mil­lion in the first year and $194 mil­lion ev­ery year af­ter that.

The re­vised reg­u­la­tions dropped a re­quire­ment that the sum­maries de­scribe the likely costs to en­rollees for breast can­cer treat­ment. Steve Larsen, di­rec­tor of the Cen­ter for Con­sumer In­for­ma­tion and In­sur­ance Over­sight at CMS, said the change re­flects con­cerns that breast can­cer treat­ment is more com­plex and less-stan­dard­ized than care for rou­tine births and di­a­betes.

The reg­u­la­tions spec­ify that the ex­am­ples are not meant to pro­vide the ex­act price for such cases, but rather “a ve­hi­cle to com­pare how dif­fer­ent con­di­tions and treat­ment sce­nar­ios would fair un­der dif­fer­ent health plans, Larsen said.

An­other pro­vi­sion dropped in the final rule is an ab­so­lute man­date that in­sur­ers pro­vide all of the re­quired in­for­ma­tion in only four pages. They will be al­lowed to en­large the dis­clo­sure be­yond four pages if they make a good faith ef­fort to first meet that limit, Larsen said.

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