Georgians For a Healthy Future

A new survey shows that consumers aren’t satisfied with the level of customer service they receive from their health insurance plans. In fact, the industry ranked the lowest of any industry measured in this survey. Additionally, other studies have found that consumers often find health insurance jargon confusing, which makes it challenging for consumers to select a policy that best meets their needs, to know what is covered and what isn’t, and to understand their rights as consumers if disputes arise. While overshadowed by some of the other major reforms included in the law, the Affordable Care Act contains some exciting reforms for consumers in this area, including making available access to clear, plain language information about their insurance plans. The U.S. Department of Health and Human Services issued final regulations on February 9^th requiring an easy-to-understand Summary of Benefits and Coverage and a uniform glossary of terms. These new tools will be available to consumers on September 23, 2012. More information is available here and here.

Beginning in 2014, many health insurance plans, including those to be offered through the new state-based health insurance exchanges, must cover a minimum package of preventive, diagnostic, and therapeutic services and products comparable to those offered in a typical employment-based plan. The specifics of the package are being developed right now by the U.S. Department of Health and Human Services (HHS), and HHS has encouraged consumer advocates to provide input. Here is how to weigh in:

Step 1: Learn more about essential health benefits and this process by reading issue summaries here and here or by participating in an upcoming webinar hosted by the National Academy for State Health Policy here.

Step 2: Prepare and e-mail your comments to ExternalAffairs@HHS.gov. HHS has requested that comments address some or all of the following 5 points below:

• In keeping with the title of the Institute of Medicine report “Essential Health Benefits—Balancing Coverage and Cost,” how can the Department best meet the dual goals of balancing the comprehensiveness of coverage included in essential health benefits and affordability?

• How might the Department ensure that essential health benefits reflect an appropriate balance among the categories so that they are not unduly weighted toward any category?

• What policy principles and criteria should be taken into account to prevent discrimination against individuals because of their age, disability status, or expected length of life as the Affordable Care Act requires?

• What models should HHS consider in developing essential health benefits?

• What criteria should be used to update essential health benefits over time and what should the process be for their modification?