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NAIC Summary of Health Plan Coverage Ready for Testing

Margaret Dick Tocknell, for HealthLeaders Media, May 11, 2011

The coverage fact labels include three examples of the costs incurred for having a baby, treating breast cancer, and managing diabetes. The care costs are specific to the experience of one individual who received that diagnosis or treatment.

I have to say that I am impressed. The information is useful and the presentation is simple. Plus everything is presented in a readable font and I didn’t see a single asterisk.

The insurance industry is supportive of the effort in general, but is not happy about being required to use real and meaningful cost examples. I had to laugh at a couple of the industry comments submitted to the committee after reviewing a draft of the SBC and coverage fact labels. There were concerns that the labels “might be confusing” or be “too complex” for the average consumer. Seriously? Have you read your own health benefit policies?

Still, in a roundabout way, the industry raises an important point – where should the line be drawn in terms of making a hard-to-understand-topic understandable without oversimplifying it to the point of compromising the usefulness of the information?

The summary of benefits and coverage will undergo two rounds of consumer testing, one by the independent Consumers Union and a second sponsored by the Blue Cross Blue Shield Association and America’s Health Insurance Plans or AHIP.

This is not us-versus-them testing. In many ways the interests of the Consumers Union, AHIP and the BCBSA are aligned. They each want to make sure that this complicated and important information is understandable and meaningful. But their approaches may be a bit different.

Consumer advocates want learn if the information is presented clearly and easily understood. The industry is interested in learning if the SBC packet contains the information consumers want and need.

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