Plans to simplify benefit information for members
June 25, 2010
In 2012, new federal standards relating to issuance of uniform benefit and coverage explanations will be implemented. Many insurers issue coverage and benefit descriptions which are difficult to understand, are incomplete and often hard to follow. Blue Cross Blue Shield of Michigan and Blue Care Network current and prospective member certificates already provide simple, easy-to-understand descriptions of plan benefits and coverage, but will conform to these additional federal requirements by 2012. The Blues have been acknowledged for clear, complete and accurate benefit and coverage descriptions, having previously received awards for Plain English and Outstanding Technical Writing by various organizations. Beginning in 2012, the Patient Protection and Affordable Care Act (PPACA), requires that plan summaries be no longer than four pages and be made available in electronic or paper format. Some required features include:
- A glossary of insurance and medical terms used in the summary
- Descriptions of benefits, including information about copayments and deductibles
- Information about applicable reductions, exclusions and limitations on coverage
- Directions about how to renew and maintain coverage
- Examples of common health situations, such as pregnancy or diabetes, and information about associated costs for members in these situations
- A contact number and website address where members can go to get copies of their actual subscriber agreements
Blue Cross Blue Shield of Michigan and Blue Care Network certificates already include many of these features. We are committed to meeting whatever additional requirements issued by the Department of Health and Human Services relating to these PPACA requirements.
The information on this website is based on BCBSM's review of the national health care reform legislation and is not intended to impart legal advice. Interpretations of the reform legislation vary, and efforts will be made to present and update accurate information. This overview is intended as an educational tool only and does not replace a more rigorous review of the law's applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. Analysis is ongoing and additional guidance is also anticipated from the Department of Health and Human Services. Additionally, some reform regulations may differ for particular members enrolled in certain programs such as the Federal Employee Program, and those members are encouraged to consult with their benefit administrators for specific details.