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Insurance & Investments for Seniors

Private Health Insurance Plans Must Eliminate Technical, Confusing Wording

Senior citizens may see help in plans for Medicare Advantage, prescription drugs, supplemental health and special needs outside Medicare

Feb. 9, 2012 - People in the market for health insurance will soon have clear, understandable and straightforward information on what health plans will cover, what limitations or conditions will apply, and what they will pay for services thanks to the Affordable Care Act – the “Obamacare” health reform law – according to final regulations published today.

“Consumers, for the first time, will really be able to clearly comprehend the sometimes confusing language insurance plans often use in marketing,” said Health and Human Services 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.”


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Senior citizens, most likely, will primarily benefit from clarification of plans for prescription drugs, Medicare Advantage Plans, supplemental Medicare insurance and private plans many purchase for services not provided by Medicare.

The new rules, published jointly by HHS, Labor and Treasury require health insurers to eliminate technical or confusing language from their marketing materials that sometimes make it difficult for consumers to understand exactly what they are buying. The new rules will also make it easier for people and employers to directly compare one plan to another.

Under the rule announced today, health insurers must provide consumers with clear, consistent and comparable summary information about their health plan benefits and coverage.

The new forms, which will be available beginning, or soon after, September 23, will be a critical resource for the roughly 150 million Americans with private health insurance today.

Specifically, these rules will ensure consumers have access to two key documents that will help them understand and evaluate their health insurance choices:

A short, easy-to-understand Summary of Benefits and Coverage ( or “SBC”); and

A uniform glossary of terms commonly used in health insurance coverage, such as “deductible” and “co-payment.”

All health plans and insurers will provide an SBC to shoppers and enrollees at important points in the enrollment process, such upon application and at renewal. In the past, health insurers would only provide selective details on a policy before it was purchased.

A key feature of the SBC is a new, standardized plan comparison tool called “coverage examples,” similar to the Nutrition Facts label required for packaged foods. The coverage examples will illustrate sample medical situations and describe how much coverage the plan would provide in an event such as having a baby (normal delivery) or managing Type II diabetes (routine maintenance, well-controlled)

These examples will help consumers understand and compare what they would have to pay under each plan they are considering.

Today’s rules finalize the proposed rules issued in August 2011. Input was received from such stakeholders as the National Association of Insurance Commissioners (NAIC) and a working group composed of health insurance-related consumer advocacy organizations, health insurers, health care professionals, patient advocates including those representing people with limited English proficiency, and others.

The final rules aim to ensure strong consumer information while minimizing paperwork and cost.

>> To view the template for the summary of benefits and coverage, visit:

>> To view the Final Rule, visit:

>> Other technical information is available at:

>> For more information on the rules announced today, visit:


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