Insurers win in the summary-of-benefits lobbying game

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Dina Overland

Dina Overland

Although the new summary of benefits and coverage final rule is billed as a consumer-driven measure, the real big winners are the health insurers.

Yes, it's true that this new standardized and easy-to-understand form will help consumers better compare health plans and, presumably, choose the most appropriate plan for themselves and their families. It certainly will make the selection process much less frustrating and overwhelming.

"Consumers dread purchasing insurance largely because they don't understand it and current health plan documents are insufficient," said Consumers Union Senior Policy Analyst Lynn Quincy, who helped develop the new summaries. "This rule is a big step in helping consumers better understand and evaluate their insurance options."

But health insurers intensely lobbied the U.S. Department of Health & Human Services after it released the proposed rule last summer, and their efforts resulted in some key victories--namely, by getting HHS to drop premium prices and the breast cancer coverage example from the summaries.

Premium cost is arguably the most important piece of information on which consumers would base a health plan selection. Although the proposed rule required that insurers include premiums in the summaries, HHS bowed to insurers' claims that too many variables prevent them accurately projecting premium costs.

Coverage examples are information designed to help a consumer to better understand how a policy works. HHS requires in the final rule that insurers provide examples for diabetes and birth, but it axed the breast cancer example, citing insurers' concerns that breast cancer treatment is too varied to easily summarize.

Combine those victories with the undeniable fact that health insurance coverage is inherently complex and confounding, and you don't exactly get a major win for consumers. Even Quincy essentially expressed the same belief. "We don't want to over-promise here about what a form can do laid over top a very complex product," she said. "We have to wait and see if the new form actually helps people." Doesn't exactly sound like a resounding victory from the consumers' side.

But despite their winning big on this issue, insurers aren't looking on the bright side of life. America's Health Insurance Plans, which conducted much of the lobbying, recognized their success but clearly was disappointed insurers weren't granted more time to prepare the summaries. The final rule "makes some important improvements over the preliminary rule, but additional time and flexibility are needed to avoid imposing costs that outweigh the benefits to consumers," said AHIP President Karen Ignani.

The "short time frame" of about six months "creates significant administrative challenges that will increase costs and result in duplication because many plans are already developing materials" for policies effective October, Ignani added.

"These new requirements involve far more than simply producing one standard form," said Kelly Miller, a spokeswoman for the Blue Cross Blue Shield Association. "Plans will need to make major and costly systems changes and produce customized benefit statements for every healthcare option."

I would suggest that insurers now turn their focus to using the summaries as a consumer outreach tool, particularly as they adapt to the emerging business-to-consumer insurance market. And since 84 percent of Americans view these coverage forms favorably, and 60 percent view it very favorably, according to a recent survey, they could be a real boon to insurers' customer satisfaction and outreach efforts. That's always a worthy goal for insurers to aspire. - Dina (@HealthPayer)