HHS announced yesterday that people in the market for health insurance will soon have clear, understandable and straightforward information on what health plans will cover, what limitations or conditions will apply, and what they will pay for services thanks to the Affordable Care Act. This is important news for Children's Mental Health Network followers. Imagine a health benefits plan that provides concise and comprehensible information about mental health plan benefits and coverage! The new rules will also make it easier for people and employers to directly compare one plan to another.
From the HHS press release
- “All consumers, for the first time, will really be able to clearly comprehend the sometimes confusing language insurance plans often use in marketing,” said HHS Secretary Kathleen Sebelius. “This will give them a new edge in deciding which plan will best suit their needs and those of their families or employees.”
Under the rule announced today, health insurers must provide consumers with clear, consistent and comparable summary information about their health plan benefits and coverage. The new explanations, which will be available beginning, or soon after, September 23, 2012 will be a critical resource for the roughly 150 million Americans with private health insurance today.
Specifically, these rules will ensure consumers have access to two key documents that will help them understand and evaluate their health insurance choices. The first is a short, easy-to-understand Summary of Benefits and Coverage ( or “SBC”); and a uniform glossary of terms commonly used in health insurance coverage, such as “deductible” and “co-payment.”
All health plans and insurers will provide an SBC to shoppers and enrollees at important points in the enrollment process, such as upon application and at renewal.
A key feature of the SBC is a new, standardized plan comparison tool called “coverage examples,” similar to the Nutrition Facts label required for packaged foods. The coverage examples will illustrate sample medical situations and describe how much coverage the plan would provide in an event such as having a baby (normal delivery) or managing Type II diabetes (routine maintenance, well-controlled) These examples will help consumers understand and compare what they would have to pay under each plan they are considering.
Why this development is important to the Children's Mental Health Network
This is just one of example of how the structure of the Affordable Care Act provides a great opportunity for education about the type of mental health services and supports that we know work for youth and families. But structure is not enough - those who make decisions about what gets funded need to better understand and support the inclusion of a wide array of mental health benefits and an expanded work force to carry them out.
- For additional perspective, read an article posted this morning in the LA Times.
- To view the template for the Summary of Benefits and Coverage and the glossary, click here
- To view the Final Rule, click here
- For more information on the rules announced yesterday, click here