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Health Reform Bans Insurance Company Fine Print, Allows Baffling Terms

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Health insurance companies must provide examples of medical costs to customers.
Health insurance companies must provide examples of medical costs to customers.

The Obama administration aims to demystify shopping for health insurance and has created a standard form that explains in plain language without the fine print what plans actually cover. What they couldn't do was make health insurance itself less complicated, so consumers will still be confronted by baffling terms including "allowed amount," "balance billing," and "usual, customary, and reasonable charges."

The health reform law requires insurance companies to use a new document that presents a uniform summary of deductibles, co-payments and other features so consumers can compare one health plan to another. The new rules also eliminate the fine print: insurers can't use a typeface smaller than 12 points. Administration officials including Health and Human Services Secretary Kathleen Sebelius unveiled the forms Thursday and companies will have to comply beginning Sept. 23.

Consumer groups including Families USA and Health Care for America Now praised the policy as an important step that enhances transparency in the health insurance market. These new summaries of benefits and costs will help people choose the right health plans and are a big improvement over the confusing information and marketing material insurance companies currently use, said Lynn Quincy, a senior policy analyst at Consumers Union who helped develop the new form.

The "plain language" isn't always so plain and the jargon-heavy nature of the form underscores that health insurance is complicated. While the administration will require that insurers provide a four-page glossary of industry terms, shoppers will have to contend with terminology that isn't always easily understandable. "We don't want to over-promise here about what a form can do laid over top a very complex product," Quincy said. "We have to wait and see if the new form actually helps people."

The insurance summary can't be longer than eight pages and includes facts about a plan such as what its deductibles are, whether benefits are capped at a certain dollar amount every year, and if patients need referrals to visit specialists. Though the administration proposed last year that premiums be listed, that requirement isn't part of the final rule. The monthly price for a health plan, which may not be available until after an insurance company has reviewed a customer's application, will be provided separately.

The form includes examples of medical expenses, such as the birth of a child, so consumers can estimate how much would be covered by insurance and how much would come out of their own pockets. The administration characterizes this feature as a “Nutrition Facts” label for health benefits.

The health insurance industry's top lobbyist said the rule places too heavy a burden on companies and takes effect too quickly. "The final rule requires an almost complete overhaul and redesign of how information must be provided to consumers," Karen Ignagni, president and CEO of America's Health Insurance Plans, said in a statement.

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