Obamacare: Senate bill limits summary of benefits to four pages

Sadly, there is no such page limit on any version of Obamacare drafted by Congress. Sen. Reid’s (D-Nev.) version of Obamacare, however, does mandate a page limit for insurance companies, and it should prove quite interesting in its implementation.

Section 2715 (beginning at page 19) provides that all insurance companies must provide a summary of benefits to each member, and that this summary can be no longer than four pages, and in type no smaller than 12 point. Here is what this four page summary must include:

Definitions, in “culturally and linguistically appropriate manner”, using “terminology understandable to the average enrollee” of the following terms: premium, deductible, co-insurance, co-payment, out of pocket limit, preferred provider, non-preferred provider, out of network co-payments, usual customary and reasonable fees, excluded services, grievances and appeals, hospitalization, hospital-out patient care, emergency room care, physician services, prescription drug coverage, durable medical equipment, home health care, rehabilitation services, hospice services, emergency medical transportation, and, “such other items as the Secretary [of Health and Human Services] determines are important”.

In addition, the summary must contain “a coverage facts label [whatever that is] that includes examples to illustrate common benefits scenarios” for pregnancy, serious or chronic medical conditions, ambulatory patient services, emergency services, hospitalization, new born care, mental health and substance abuse disorder services and treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services, and, pediatric services including oral and vision care.

The four page summary must also include a contact telephone number and a Web site for people to contact if they have any questions.

And, finally, the four page summary must include the following language:

a statement that the outline is a summary of the policy or certificate and that the coverage document itself should be consulted to determine the governing contractual provisions.

So, assuming that anyone reads the mandated four page summary, this last provision essentially tells that person that they should ignore the summary and read the policy itself to find out what’s covered, and what isn’t.

Curiously, it only took Congress seven pages to list (without defining) what insurers must define in a four page summary. This should be interesting.

But, this section of the bill does show us something…how out of touch Congress is with the real world.  The bill spends 7 pages discussing and mandating the production of a meaningless 4 page document that no one will read, while spending 16 lines mentioning, but failing to deal with, tort reform.

Added by Steve: Looking for an example of the policy or certificate? Insurance companies refer to these contracts as a certificate of coverage (COC) or summary plan description. Insurance companies have hundreds of plans to choose from, and – for those of you who have employer-based coverage – your employer chooses the plan that includes the coverage they want to provide.

For a small business with less than 100 employees the coverage options and plans are pretty standardized, but for companies with more than 100 employees or for corporations who have chosen to self-insure and have the insurance company provide administrative services only, the COC can be a very detailed contract.

Here is an example dental benefits COC available online from the American Federation of Teachers Union. The contract is it’s 52 pages and it only covers dental. Imagine what a medical COC includes!

3 replies
  1. Dimsdale
    Dimsdale says:

    “terminology understandable to the average enrollee”

     

    I just loved that!  What a shame the fabricators of this giant bill couldn't do the same!  Heck, just writing it so the average senator or congresscritter could read it, presuming they would bother.   When the inevitable results of this crappy legislation come to pass, they will sit there like a prison guard at the Nuremburg trials, claiming they were only "following orders".

     

    I think it is time to resurrect one of the Dem's favorite words: scheme.

    • Dimsdale
      Dimsdale says:

      Well, I may be succumbing to the ability of our "representatives" to throw billions of dollars around like it is their money, but I never give up.

       

      How could I work in academia and stay sane otherwise?  😉

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