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U.S. Completes Rules for Describing Health Insurance Plans

Health insurance companies must provide easy-to-understand summaries of benefits and coverage and a glossary of terms under final rules issued today by the Obama administration.

The final draft removed a section providing an example on how much it would cost a patient to be treated for breast cancer, bowing to arguments made by the lobby group America’s Health Insurance Plans that the condition was too complex to be easily summarized.

“There was concern expressed that breast cancer was a more complicated treatment scenario, that the treatment scenario wasn’t always standardized across issuers,” Steve Larsen, director of the U.S. Center for Consumer Information and Insurance Oversight, said on a call announcing the final rule.

Consumers will get the forms when they apply for a new plan or have their coverage renewed. The eight-page document outlines a patient’s co-payments for drug, doctor and hospital care, any deductibles or limits on coverage, and what services the plan does and doesn’t cover.

The rules will let consumers make an “apples to apples” comparison of insurance plans, U.S. regulators said. “We want this to be useful to as many people as we can,” Larsen said.

The form currently provides examples on how much it might cost a patient to get treated for Type 2 diabetes, as well as a normal delivery of a baby. As many as six other examples may be added in the future, Larsen said.

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