AHA proposes additional changes to health plan benefit and coverage summary

The AHA today urged the departments of Labor, Health and Human Services, and Treasury to quickly address several sources of confusion in the Summary of Benefits and Coverage given to health plan enrollees. “The AHA recommends that the SBC glossary be revised to adopt standardized terms that better match provider classifications and that are more familiar to consumers,” wrote Linda Fishman, AHA senior vice president of public policy analysis and development. “We also recommend that the SBC format and instructions require plans to list coverage and cost sharing for each tier or type of provider [in a tiered provider network]. The format could follow the same approach already used for tiered drug benefits.” In addition, AHA recommends that SBC hyperlinks to provider networks direct the viewer to the specific network used by that plan or specify which provider directory on an issuer’s website pertains to that plan. Among other changes, AHA recommends that required documents clarify exclusions to out-of-pocket limits for out-of-network providers; and that changes to SBC rules and companion documents for 2016 be limited to the glossary or template instructions, which would allow more time for stakeholder review of other recommended changes.