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Consumer-Friendly Health Plan Briefs Coming Soon

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Flickr User Medill DC

Don’t have the slightest clue what your health insurance covers?

The Obama administration says that’s going to change, starting this year. Officials announced Thursday that private health plans will have to provide consumers with a user-friendly summary of what’s covered, along with key cost details such as copays and deductibles.

Just six pages long. And no fine print.

Officials are calling the summaries a “nutrition label for health care,” trying to capitalize on the name recognition of those information panels found on packaged foods at the supermarket. Consumer groups say the health care version isn’t perfect, but it’s a start.

For example, the summaries won’t include premiums. Administration officials said they ran into logistical problems trying to do that, and that premiums will be easily available anyway to consumers, either from their employer or from a health plan directly.

“These documents will allow consumers to compare plans on an apples-to-apples basis,” said Medicare chief Marilyn Tavenner, who is also overseeing implementation of President Barack Obama’s health care law. If an insurance plan offers substandard coverage in some respect, they won’t be able to hide it in dozens of pages of text, she added.

The new summaries are required under the health care law, and most consumers will start seeing them this fall during open enrollment. The requirement takes effect Sept. 23 and applies to all private insurance, including employer coverage and plans purchased individually, affecting about 150 million Americans.

Although the health system overhaul itself continues to divide the public, a major poll last year found that 84 percent of Americans support the provision requiring insurance summaries.

These summaries could prove particularly important for people buying coverage directly from an insurer. From now on, they will have a standard format for comparing plans.

Many employers currently give such information to their workers in the health plan summaries they provide during open enrollment. But the federal comparison goes further. It requires something new — so-called “coverage examples” that give a ballpark estimate of the cost for a typical individual for two common health conditions: normal childbirth and managing diabetes.

The preliminary version of the regulations also called for an example focusing on breast cancer treatment. But Health and Human Services officials said that proved too complicated, since there are different approaches to treatment.

“We didn’t take this off because it happens to be more expensive,” said Steve Larsen, head of the Center for Consumer Information and Insurance Oversight. “It just needed more work.”

In the future, up to six such coverage examples may be required, he said.

Consumer representatives, insurers and employer groups are poring over the fine print to see how the administration balanced concerns about providing full disclosure while keeping compliance costs affordable for businesses.

The administration appears to have tried to take both sides into consideration.

For example, large employers had asked that the requirement be phased in over a longer period for them. Instead, they will have to comply this fall, in most cases for coverage that starts Jan. 1, 2013.

Insurers and employers had complained that providing paper copies of the summaries would be a huge new cost. The administration will allow them to comply by providing an online version, but consumers must be told that they can receive a paper copy promptly upon request.

In an election year, the administration is sensitive to criticism of government overreach through regulations.

(Copyright 2012 by The Associated Press. All Rights Reserved.)

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