The Departments of Health and Human Services (HHS), Labor (DOL), and the Treasury proposed new rules under the Affordable Care Act (ACA) to assist employers find coverage for their business and their employees. Likewise, these proposed rules are also geared to help consumers understand their health coverage and determine the best health insurance options for themselves and their families.

Under the proposed rules, health insurers and group health plans will provide consumers with clear, consistent, and comparable information about their health plan benefits and coverage. The new forms are scheduled to be available in 2012.

The rules will also help consumers understand the coverage they already have and, when purchasing new coverage, compare available options. Specifically, the proposed regulations would ensure consumers have access to two forms that will help them understand and evaluate their health insurance choices, including:

• An Summary of Benefits and Coverage; and
• A uniform glossary of terms commonly used in health insurance coverage

All health plans and issuers will provide a Summary of Benefits and Coverage, along with a uniform glossary of terms, to shoppers and enrollees upon request and before they buy coverage. Often, health plans and issuers only provide selective details on the plan or policy before it’s purchased, giving consumers a limited understanding of what they are buying. The proposed rules give consumers straightforward, standardized information on their choices upfront, helping them understand the key features of the policy or plan and allowing them to make a more informed decision. The summary will use a uniform glossary to replace the jargon that makes it impossible to compare plans or figure out what is covered. Health plans and issuers must also provide notice at least 60 days before any significant modification is made in the plan or coverage during the plan or policy year.

This Summary of Benefits and Coverage will include a new, standardized health plan or policy comparison tool for consumers known as “Coverage Examples.” The Coverage Examples would illustrate what proportion of care expenses a health insurance policy or plan would cover for three common benefits scenarios—having a baby, treating breast cancer, and managing diabetes. Additional scenarios may be added in the future.

The proposed rules benefit from the public process led by the National Association of Insurance Commissioners (NAIC) and a working group composed of stakeholders. Today’s proposed regulations adopt the recommendations submitted by the NAIC after that process, and request comments on how the forms can be improved.

The government has posted additional information about:

• The proposed regulation
• The proposed template for the Summary of Benefits and Coverage
• The Notice of Proposed Rulemaking or learn how to submit public comment