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BNA's Health Care Daily Report

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HHS, DOL, Treasury Final Rule Aim to Make Insurance Coverage Understandable

Posted February 9, 2012, 12:50 P.M. ET

A new final rule providing an “easy to understand” summary of benefits and coverage and a uniform glossary of terms used in health insurance coverage was jointly released Feb. 9 by three federal agencies—the departments of Labor, Health and Human Services, and Treasury.

The goal of the final rule is to provide “clear, understandable and straightforward information on what health plans will cover, what limitations or conditions will apply, and what they will pay for services,” HHS said. The rule was required by the Patient Protection and Affordable Care Act, it noted.
The final rule is effective 60 days after publication in the Federal Register, which is scheduled for Feb. 14.

The agencies also issued a guidance document on compliance with the rule.
Under the rule, insurers must provide consumers with clear, consistent, and comparable summary information about their health plan benefits and coverage. New forms, which will be available around Sept. 23, HHS said, “will be a critical resource for the roughly 150 million Americans with private health insurance today.” HHS said the final rule aims to “ensure strong consumer information while minimizing paperwork and cost.”

For example, in the past, insurers would only have to provide selected details on a policy before it was purchased. Under this rule, all plans and insurers will have to provide a summary of benefits and coverage to shoppers and enrollees at certain points in the enrollment process, such as upon application and at renewal, HHS said.

The proposed rule was published Aug. 22, 2011.

The guidance for compliance and notice of availability of templates, instructions, and related materials is available at The final rule regarding the summary of benefits and coverage and the uniform glossary is available at