According to a new report from Families USA, employees will have a better understanding of their benefits once the new summary of benefits and coverage requirements are implemented in September.
The report suggests that when employees better understand their benefits, they make wiser consumer decisions and are smarter when it comes to benefits usage.
“Without a clear understanding of what a policy covers, consumers may delay or forgo care, make wrong choices about treatments, and even end up with unexpected health care bills,” says Ron Pollack, executive director of Families USA. “When comparisons and choices are stated in plain language, families will know what benefits are provided and will be able to make coverage choices based on their needs as well as the costs they will incur.”
Once the new requirements go into place, nearly 19 million nonelderly Americans using private coverage will be helped by the summary of benefits and coverage, and 90 percent of those who will benefit from the new guidelines are insured under employer-sponsored plans, the report finds.
The report also states that the summary of benefits and coverage will be helpful as a shopping tool because so many Americans have multiple health plan choices. In fact, 65.6 percent of all workers have their choice of employer-sponsored health plans. While 8 million people employed at small businesses have a choice between multiple plans, 43 million people employed at large businesses also have access to more than one plan.
“Health plans clearly win the prize for being the most difficult major product for families to compare,” Pollack says. “Now, consumers will have a simple, easy-to-use tool that will make clear what their health plan covers, just like nutrition labels tell us what's in our breakfast cereal.”
According to Families USA, the summary of benefits important additional information for policy holders that will be available are their rights to continue coverage and appeal health plan decisions, information on finding answers to coverage questions, which providers participate in the plan’s network, the cost difference for using outside providers, which prescription drugs are covered and how to attain immediate access to specific details of coverage.
“The new requirement that insurers provide a summary of benefits and coverage is a little-known provision of the Affordable Care Act, but it is one that every health insurance consumer will value,” Pollack says. “Like virtually every provision of the health reform law, it addresses a real problem — trying to understand one’s policy or compare health policies — that families have faced for years, and soon effective help will be available. The summary of benefits and coverage will make us better, more-informed shoppers for health insurance, a purchase that is so vital to us and our families’ well-being.”