Here Is What The New Health Insurance Labels Will Look Like

Back in August, we told you about how the Dept. of Health & Human Services was finalizing a template for new health insurance labels that would attempt to make it clear what a potential customer was buying and what sort of coverage they would receive.

Today HHS revealed the final format of the label. Above is what the first page of the 6-page template (see the whole PDF here). Subsequent pages cover costs and limitations for in- and out-of-network care for a variety of common expenses like doctor’s visits, prescriptions, tests, mental health, substance abuse treatment, prenatal care, dental or eye coverage.

“All consumers, for the first time, will really be able to clearly comprehend the sometimes confusing language insurance plans often use in marketing,” said HHS Secretary Kathleen Sebelius. “This will give them a new edge in deciding which plan will best suit their needs and those of their families or employees.”

Insurers are expected to begin using these labels in their marketing and sales materials starting around September 23, 2012.

“A driving force behind the Affordable Care Act was to make the health insurance market work for consumers,” said Lynn Quincy, senior policy analyst for Consumers union, the policy and advocacy division of Consumer Reports. “The new Summary of Benefits provides consumers with important insurance information in a standardized way for the first time. Our consumer testing showed that consumers dread purchasing insurance largely because they don’t understand it and current health plan documents are insufficient. This rule is a big step in helping consumers better understand and evaluate their insurance options.”

The labels all use a common glossary (PDF) so that insurers can not say “that’s not what we meant by ’emergency services.'”

Quincy adds, “By making the terms of health insurance plans easier to understand, consumers are less likely to find themselves in health plans that don’t meet their needs. We appreciate that HHS recognizes consumers would benefit from additional coverage examples.”


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  1. TuxthePenguin says:

    And yet the most important words on that document are as follows:

    “This is only a summary – if you want more detail about your coverage and costs, you can get the complete terms…”

    Basically, nothing on this document is going to be legally binding as there are more terms and conditions that are not disclosed.

    Now I wonder how much our government spent making this…

    • SabreDC says:

      There’s a difference between a summary and a non-binding estimate. This is a summary. While the full terms would be disclosed elsewhere (e.g. which costs of care are paid in full toward the deductible and which are copaid with the deductible waived), they won’t be allowed to say the deductible is $10,000 and in the fine print say “No it’s not, the deductible is $20,000.”

    • Tim says:

      Yes, just like the Schumer box and the Monroney sticker. It’s meant to make people understand the terms better, not to replace the terms.

  2. pop top says:

    I see nothing wrong with requiring companies to create contracts/forms/whatever that are easily readable and in plain English, with specific fees and charges spelled out clearly. How is making sure that everyone can make a smart, informed decision a bad thing?

    • Firevine says:

      I work with printer technology, and every day, I see just how many people utterly lack the ability to make smart, informed decisions, even with a wealth of information at their disposal.

      • RvLeshrac says:

        That’s because the manufacturers flood the market with bullshit, not information, and it drowns out everything else.

        The lowest point of this in recent memory has been television contrast ratios. “Our new TV has a 63 BILLION to 1 contrast ratio!*

        *Measurements taken in a mirrored room, filled with floodlamps, with sensors disabled, from an off state, to full-illumination of a bright-white screen, brightness and contrast settings turned to maximum

    • Nigerian prince looking for business partner says:

      I’m a massive critic of the ACA and I think this is a step in the right direction. Hopefully, we’ll see the same tax advantage given to those in group plans expanded to those without that luxury and the exchange actually will provide a competitive market place.

      Anything that breaks the link between health care and one’s employer is a good thing.

      • sponica says:

        in order to have a competitive marketplace, wouldn’t you need competition? there’s only ONE insurance company in the state of NH. unless you’re a teacher and can get a plan administered by SchoolCare, you’re stuck with Anthem/BCBS…

        I can’t wait til I get group insurance again, it’s a hell of a lot cheaper per month than my HDHP…even though I’ll still have to deal with Anthem/BCBS. I miss my mom’s Cigna administered by SchoolCare plan, they weren’t completely incompetent and sent you a statement every time you visited a doctor to let you know a doctor’s visit had been made and how much it cost.

        • Nigerian prince looking for business partner says:

          Yup, that’s still a major problem. It sucks living in a small state. My state has amongst the lowest salaries but the highest health insurance premiums in the country. Part of the reason why the system is so broken is that most people are stuck with whatever they have through work. It generally works out OK if it’s decent insurance and is heavily subsidized but sucks if your group is unhealthy or the subsidy is low.

          I just escaped a terrible group plan (also through Anthem BC/BS) and switched to Highmark, saving around $800/month. Even with all the extra taxes, that ~ $9,000/year in savings goes a long way towards paying for health care.

          • sponica says:

            at my old non-profit company they couldn’t afford the PPO anymore, so they offered the HMO and a HDHP/HSA. the coverage was about the same as when I was on my mom’s plan, but the copays were higher and there was no benefit to ordering prescriptions via mail order.

            i’m sure the premiums were very different for families, but for a single person, the difference b/w the two plans wasn’t worth doing the HDHP/HSA (despite the fact my HR office wanted everyone on the HSA) and half my coworkers who had the HSA had to spend their time at the office making sure bills got paid.

            based on the conversations I’ve had with my friends in other northeastern states, I’ve either had better coverage than them or the same coverage but at a greater pre-tax cost. but I only know what non-profits provide for insurance, I’ve never had to deal with insurance in a for-profit situation.

  3. Nigerian prince looking for business partner says:

    I think this is definitely a step in the right direction. However, it’s very easy to compare deductibles, out-of-pocket maximums, network status, etc. in the current system. It’s the nuts and bolts of a plan that require pouring through the plan booklets — It would be nice if this information was put into a standardized matrix to make it more easy to compare plans. There are many very little parts of a plan that you don’t think about until you have a claim, like what’s required to get an MRI, if 12 or 15 physical therapy sessions will be covered, limits related to speech therapy, etc.

    I just went through the process back in November & December of working with a broker and finding a new policy. Comparing plans actually wasn’t all that difficult, it was digging up all the medical records and physician statements that was the real headache.

    • Quixiotic... Yea it's a typo (‚ïج∞‚ñ°¬∞Ôºâ‚ïØÂΩ°‚îÅ‚îª says:

      I’m inclined to believe that the majority of people are concerned with base prices as that’s what’s keeping them from having any coverage at all. Sure people should be concerned with what’s needed for an MRI or how many physical therapy sessions are covered, but for those who don’t have anything, this will get them the basics covered and from there they can shop around.

      • Nigerian prince looking for business partner says:

        According to KFF, all of their models are based on individuals choosing the cheapest plan, in the bronze tier that they can find. So, there’s definitely truth to that.

        I think there are still a lot of people in my situation where insurance through work is too expensive, so it comes down to finding a non-group policy that offers similar coverage for less total out of pocket (combined premiums and deductibles) annually. There are a lot of people stuck paying $1,000 – $2,000/month for pretty crappy coverage. Unfortunately, this is unlikely to change.

        • sponica says:

          I find that figure mind-boggling….guess I shouldn’t be too upset that my insurance rates are going to 191 a month on April 1. and it’s decent enough coverage for my needs. 4 office visits a year with a 30 dollar copay, everything beyond that goes toward the deductible. annual deductible of 3000. that being said I hope I’ll be back on group insurance by April 1…

          • Nigerian prince looking for business partner says:

            Yeah, premiums are out of control in many states. The plan I left was bumped up to $1,200/month with a $5,000 deductible. We switched to a non-group policy for around $400/month with a $10,000 deductible. The downside is that it doesn’t cover prescriptions or maternity and is essentially just major medical, hospitalization insurance.

  4. ARP says:

    I don’t like that they spent all this money to create a form. They should have just used the plain English standard that the FTC uses for consumer protection.

  5. Cat says:

    “My government gave billions of my dollars away to the health care industry, and all I got was this stupid label.”

  6. Greg Ohio says:

    Anything that makes it harder for a corporation to rip you off is Socialism.

    The GOP

    • Coffee says:

      “Why is the government wasting money on something like this?”

      -The GOP

      • eeelaine says:

        “Because it’s useful to have a standard written in clear, organized language so that consumers can understand what they are buying.”


  7. rlmiller007 says:

    I am not for government regulation but these companies are out of control…ha ha you guys get what you get. Oh, and if you raise price to penalize us I hope you get that regulated too.

  8. jaydub says:

    There’s a typo on Page 3 of the form–the “i” in “immediate medical attention” should be capitalized. Sheesh. I hope they didn’t pay anyone lots of money to produce this….

    However, I’m in favor of it. Something the industry should have done themselves.

  9. rsjames says:

    Yay! Now I can understand exactly what I would be getting if I was actually able to buy insurance! But since the government wants only people that work for someone else to have insurance, I’m screwed. Thanks!

  10. Miss Dev (The Beer Sherpa) says:

    Now if we could only get a menu of prices from each doctor’s office. That would be fabulous.

  11. Cor Aquilonis says:

    It astonishes me that people want to create an insurance market where customers can easily shop between plans, but they won’t make standardized contracts. Just like commodities contracts or options contracts, we won’t have a good market until health insurance agreements are standardized.

  12. khooray says:

    They’ve used charts like this for Medicare insurance for years.