Welcome to 2013 and the new health care laws. Even those people not in favor of the Affordable Care Act and all its provisions will likely applaud this one: a plain English requirement for plan summaries.
No longer will health insurance companies be allowed to use language like this:
“Benefits are payable for Covered Medical Expenses (see ‘Definitions’) less any Deductible incurred by or for a Covered Person for loss due to Injury or Sickness subject to: (a) the Maximum Benefit for all services; (b) the maximum amount for specific services; both as set forth in the Schedule of Benefits; and (c) any coinsurance amount set forth in the Schedule of Benefits or any endorsement hereto. The total payable for all Covered Medical Expenses shall never exceed the Maximum Benefit stated in the Schedule of Benefits. Read the ‘Definitions’ section and the ‘Exclusions and Limitations’ section carefully.” [From Consumers Union via a Wendell Potter blog.]
The new simplified explanation is a standardized four-page summary. Insurers will also have to provide a glossary for terms such as “deductible” and “co-pay.” Here’s a portion of the sample form:
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