New forms aim
to make health
coverage user
friendly
by Marcella Durand
They won’t provide calorie counts, but new standardized
health insurance forms are
intended to provide the same
accessibility of information that
the Nutrition Facts label on food
packages does.
ROBERT KIRK/GETTY IMAGES
“Imagine that instead of
nutrition and ingredients, you’re
talking about components of
health insurance,” said Kimberly
Calder, director of Federal
Health Affairs and Insurance
Policy at the Society. “You
can see how much Plan A will
cover if, for instance, you gave
birth, or had a serious health
condition like diabetes.” The
health-care reform law also calls
for standardized summaries
of coverage and a glossary of
common health insurance
terminology.
“People don’t realize how much
of their health care their insurer
will or won't cover until they use
it a lot. If they are living with
MS, it’s especially important
to get the most out of their
insurance coverage,” Calder
added. “That is how these forms
are going to work—by enabling
consumers to compare the costs
of different plans when choosing
coverage.”
Calder served as an official
consumer representative to
the National Association of
Insurance Commissioners,
which was charged by the
Affordable Care Act (ACA) with
developing a set of standardized
forms to help people better
understand their coverage—and
coverage options.
What the forms are
The new forms will consist of
three parts:
•;A summary of coverage,
including a chart illustrating
what a plan will cover
and what it costs, along
with FAQs on premiums,
deductibles, out-of-pocket
costs, annual limits and
more.
•;A;glossary;of;commonly
used medical and
insurance terms.
•;Templates;that;show
how much a plan will
pay for the average cost
of three common
medical conditions:
diabetes, breast
Policy
cancer and normal delivery of a
baby. “The idea is to really make
it clear to the consumer how
much health insurers A, B and
C will cover if the consumer had
one of these conditions,” said
Calder. Additional templates
of other common conditions
may be developed as the forms
become more established.
When they go into effect
The law requires that all health
insurers and employers offering
new health insurance provide
the forms by March 2012. New
insurance is defined as a contract
signed after the ACA took effect
in March 2010; plans that were
already in existence at that time
are not required to provide the
standardized forms.
“Eventually, as plans expire
or change significantly, and
new contracts are signed,
they will be considered new,”
added Calder. However, there
is a possibility that the March
2012 deadline may be changed
to give insurers more time to
incorporate the forms into their
systems.
The proposed forms were
tested on “real consumers,”
said Calder, in one-to-one
interviews, as well as in focus
groups. And the results were
positive. “Consumers looked
at this and they went, ‘Wow,
these really help me understand
coverage.’ ” n
Marcella Durand is the associate
editor of Momentum.
