The Centers for Medicare and Medicaid Services is nearly ready to issue a proposed rule requiring health insurers to develop standardized, consumer-friendly summaries of benefits and coverage under their health plan packages.

The rule, mandated under the Affordable Care Act under Sec. 2715, would cover all benefit packages including those that individuals and small employers will be able to compare and purchase on Web-based state insurance exchanges. CMS has sent the proposed rule to the Office of Management and Budget for review, which is one of the last steps before publication in the Federal Register.

Standard definitions for insurance terms will cover premium, deductible, co-insurance-co-payment, out-of-pocket limit, preferred provider, non-preferred provider, out-of-network co-payments, UCR (usual, customary and reasonable fees), excluded services, grievance and appeals, among others.

Standard definitions for medical terms will cover hospitalization, hospital outpatient care, emergency room care, physician services, prescription drug coverage, durable medical equipment, home health care, skilled nursing care, rehabilitation services, hospice services, and emergency medical transportation, among others.


Register or login for access to this item and much more

All Health Data Management content is archived after seven days.

Community members receive:
  • All recent and archived articles
  • Conference offers and updates
  • A full menu of enewsletter options
  • Web seminars, white papers, ebooks

Don't have an account? Register for Free Unlimited Access