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Feds Release Final Rules on Health Plan Language

Cheryl Clark, for HealthLeaders Media, February 10, 2012

A third category of a healthcare service that was listed in the proposed rule, treatment of breast cancer, was dropped in the final rule because of concerns that breast cancer treatments are widely variable, but Steve Larsen, CMS Director of the Center for Consumer Information and Insurance Oversight, said that six other healthcare categories of service that are considered expensive will be added in future rulemaking.

Also dropped from the proposed rule is the requirement that plans list their premiums because those rates vary by medical status, family size and other factors and CMS officials said they thought it would be unnecessarily confusing. Besides, all health plan shoppers would already know their premium rates. "The information is readily available in a number of other formats," Larsen said.

The new rule carries a penalty for any plan that “willfully fails to provide the information required under this section" that does not exceed $1,000 for each failure.

Other elements of the new rule include

  • A specific glossary of terms used in health insurance marketplace such as "deductible" and "co-payment."
  • Requirements that plans make these documents available when applicants are shopping for coverage, when changes are made prior to the first day of coverage, upon coverage renewal or upon request.
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1 comments on "Feds Release Final Rules on Health Plan Language"


Arcpoint Sarasota (2/13/2012 at 12:40 AM)
Good information regarding changes in the medical community.