Because of a new health care law which took effect on Sept. 23, millions of Americans will have access to standardized, easy-to-understand information about health plan benefits and coverage. Insurance companies and employers are now required to provide consumers in the private health insurance market with a brief summary of what a health insurance policy or employer plan covers, called a Summary of Benefits and Coverage (SBC). Additionally, consumers will have access to a Uniform Glossary that defines insurance and medical terms in standard, consumer-friendly terms.
These tools will also assist employers in finding the best coverage for their business and employees.
“Thanks to the health care law, Americans will now get clear, consistent and comparable information when shopping for health coverage,” said Health and Human Services (HHS) Secretary Kathleen Sebelius. “These new tools empower consumers to make informed decisions about their health coverage options and to choose the plan that is best for them, their families, and their business.”
The SBC includes a new comparison tool, called Coverage Examples, which is modeled on the Nutrition Facts label required for packaged food, that helps consumers compare coverage options by showing a standardized sample of what each health plan will cover for two common medical situations—having a baby and managing type 2 diabetes.
The SBC will include information about the covered health benefits, out-of-pocket costs, and the network of providers. The glossary defines terms commonly used in the health insurance market, such as “deductible” and “co-pay,” using clear language.
Before Sept. 23, people often lacked uniform and comparable information when shopping for coverage, often relying only on marketing materials to make decisions. Starting this fall, consumers will receive the SBC free of charge and in writing from the consumers’ insurance company or employer. This information can be requested at any time, but it will also be made available when shopping for, enrolling in or renewing coverage. It will also be provided whenever information in the SBC changes significantly.
The SBC is now available for consumers in the individual health insurance market. For enrollees in group health plans enrolling during an open enrollment period, it will be available during the next open enrollment period that started on Sept. 23, 2012. For enrollees who enroll outside of an open enrollment period, it will be available at the start of the next plan year that began on or after Sept. 23, 2012.
The SBC and Glossary were developed in collaboration with the Department of Labor, Department of Treasury, consumer groups, the insurance industry, State Insurance Commissioners, and other stakeholders.
For more information the SBC announcement, please visit: www.healthcare.gov/law/features/rights/sbc/index.html
For a sample SBC, please see: cciio.cms.gov/resources/files/sbc-sample.pdf
For the SBC template, please visit: cciio.cms.gov/resources/files/sbc-template.pdf
For the Uniform Glossary, please visit: cciio.cms.gov/resources/files/Files2/02102012/uniform-glossary-final.pdf