Helping companies and individuals select a policy – by deciphering exactly how much plans will cover for medical procedures – isn’t exactly what insurance companies are known for. Hopefully, that’s about to change.
Tucked in the healthcare reform law was a requirement that all insurance carriers selling group or individual health plans provide easy-to-understand treatment “coverage facts labels” — to aid in consumer and group plan sponsor comparisons.
The intent of the labels is to provide an idea of how much plans will cover and how much participants will be expected to pay out of pocket for medical care.
Currently, insurers are only required to provide three treatment labels, one each for:
- maternity care
- diabetes treatment, and
- breast cancer treatment.
The labels will provide coverage limits — in exact dollar figures — based on national averages.
They are meant to give consumers and prospective plan sponsors an easy way to make apples-to-apples comparisons of how much medical coverage costs plans will actually cover.
What’ll be listed
For example, when it comes to breast cancer treatment, an insurer will be required to list how much patients would pay (based on national averages) for:
- office visits
- lab tests
- surgery
- chemotherapy, and
- medication.
(To see samples of the proposed insurance coverage facts labels, click here.)
If a plan does not offer coverage for one of these three types of care, the label would show that the patient is responsible for the entire treatment cost.
Rules coming along slowly
The label requirement is scheduled to take effect in March 2012. However, the rules were supposed to have been issued by this past March.
According to a recent Kaiser Health News Report, developing the model format and language for the rules has proven to be difficult and time consuming — causing the delay.
Whether the delay will push back the enforcement date of March 2012 is yet to be seen.
We’ll keep you posted.
Do you think these requirements will help your company select a health plan in the future? Share you opinions in the Reply box below.
