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Your Health Plan - In Plain English

Ruby de Luna

Do you know the difference between a co–pay and co–insurance? Does your health plan have one, or the other, or both? Beginning next year, health insurance companies must provide information on health benefits in plain English. That's a new requirement announced Wednesday by the federal government. As KUOW's Ruby de Luna reports, the goal is to make it easier for consumers to get clear, consistent information when shopping for health plans.


Trying to understand the different options offered by health plans can be confusing and time consuming. In a telephone press conference Wednesday, the Department of Health and Human Services announced a new rule requiring insurance companies to explain their health benefits in plain language.

Dr. Donald Berwick is director of the Centers for Medicare and Medicaid Services. He says consumers can expect two key documents: one document that lists a summary of benefits, and another that has a uniform glossary of insurance terms. Berwick says the information will be standardized, just like nutrition labels on packaged foods.

Berwick: "That will allow consumers to compare plans on apples–to–apples basis. And these documents are going to bring much needed sunlight to the health insurance market. If an insurer's plan offers subpar coverage in some area, they won't be able to hide that in dozens of pages of text."

The requirements are part of the mandate under the national health care law. They were developed by the National Association of Insurance Commissioners.

Insurers are concerned the new rules would add to their administrative costs, but some analysts say providing straightforward information is good for consumers. Doug Conrad is professor of health services in the University of Washington's School of Public Health.

Conrad: "Seems to me all those things are going to get much more transparent if we start to simplify and aggregate some of the presentation of information, and there will be costs to that. I mean, we'll make mistakes. It'll be oversimplified sometimes. I just think the cost to those mistakes is less than the likely cost of sticking with what we have, which is a very complex set of information to wade through and understand."

Health and Human Services will take public comments before finalizing the rules. Health insurers will be required to provide simplified information beginning next March.

I'm Ruby de Luna, KUOW News.

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