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PPACA Benefit Schedule Rules Released


PPACA Benefit Schedule Rules Released

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According to federal officials, all health insurance plans will be required, under the PPACA,to provide consumers with a simplified summary of benefits and coverage and related documentation beginning in March 2012 under new rules.

These requirements will not be structured like a typical health insurance plan's "schedule of benefits". Instead the coverage breakdowns will provide more real-life consumer-oriented examples such as a child's ear infection, managing Asthma, or cancer treatment


The Department of Health and Human Services says insurance shoppers and enrollees will receive a standardized policy comparison form that HHS compared to the nutrition labels on packaged foods.

The rule is designed to address a lack of information about health benefits among consumers, who often have a difficult time wading through explanations of benefits that are couched in highly technical language that is not easily comparable from plan to plan.

The examples will illustrate the scope of coverage offered by the plan or policy, according to HHS. Health plans will also be required to offer a uniform glossary of terms upon request


The rules have been delayed significantly as they were orginally scheduled for a March 2011 release under the Affordable Care Act. The National Association of Insurance Commissioners played a significant role in the rules' development.

America's Health Insurance Plans (AHIP) Press Secretary Robert Zirkelbach released the following statement on the proposed Summary of Benefits and Coverage rule released by HHS. While health plans seek to provide user-friendly tools, the new rules could require some health plans to create "tens of thousands of different versions" of the consumer tools, said Zirkelbach. With nuances among the various healthn plans offered by a large insurer the AHIP spokesman may be right. That would definitely fall into a possible unintnded hardship facining health plans.

AHIP is also hoping that the implementation dat of these changes will be delayed just as the rules release has been.

Meanwhile, Montana Insurance Commissioner Monica Lindeen dismissed industry concerns that the rules could lead to more confusion or that the tools should be provided when a consumer makes an enrollment application. "It's hard to make decisions without getting the information up front," said Lindeen, vice chairwoman of the NAIC's Health Insurance and Managed Care Committee.

Insurers are concerned that the administrative costs associated with these labels will raise the price of the plans themselves. Kim Holland, executive director of state affairs at Blue Cross Blue Shield Association, told Employee Benefit News that insurers support people knowing what they are getting, but echoed that concern. "The concern is we already have a body of law that tells us what we need to have," Holland said before the rule's release.

The six-page labels follow the recommendations of a group formed by the National Association of Insurance Commissioners that included insurance companies, consumer groups and academics.

HHS recently announced new rules to guide states in setting up health insurance exchanges and in what preventive care must be covered going forward under health care reform implementation.

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