Insurance Outreach and Education
Educating consumers about their rights and responsibilities under state and federal insurance laws and regulations can help them make better decisions when purchasing and using health insurance.
*Milestone details:
*Full name: Create a plan for educating consumers about their rights and responsibilities as defined by the ACA insurance provisions.
*Relevance to the ACA:
The ACA provides consumers with a number of new rights and responsibilities. The ACA does not require states to educate consumers, but does make establishing an office of consumer assistance or ombudsman a condition of receiving a consumer assistance grant. Relevant sections of the ACA include:
§1002 - Creates consumer assistance grants for states to establish an office of health insurance consumer assistance or ombudsman. The consumer office or ombudsman is required to assist with consumer complaints and appeals, quantify problems reported by consumers, assist consumers with enrollment, resolve problems with obtaining premium tax credits, and educate consumers about their rights and responsibilities with regard to insurance coverage. States that receive this grant must also report to the Secretary of HHS on the types of problems and inquiries they receive from consumers.
§1311 - Exchanges must require plans seeking certification to publish on a website and through other means information about the amount of cost-sharing (including deductibles, copayments, and co-insurance) under the plan.
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Washington
I have become aware of numerous state-specific SBC requirements (filing/state-specific supplements), and was hoping others could share similar regulations in other states (assuming my information is not complete). The following are states which have released information on these requirements:
Alabama: Bulletin No. 2012-05 (released July 9, 2012)
Colorado: 3 CCR 702-4, Amended Regulation 4-2-20
Michigan: Bulletin No. 2012-10-NS (released May 31, 2012)
Montana: Regulatory Activity Advisory Memorandum of July 6, 2012
Virginia: Regulatory Activity Administrative Letter 2012-8
If anyone knows of others, please post them!
District of Columbia
Hi Dustin-
This is the most comprehensive list we've seen so far. This area isn't something we've been specifically tracking, so we welcome others to share if they've found anything.
District of Columbia
On February 9, 2012, HHS released final rules related to insurance labeling and benefit descriptions. Specifically, these rules will require that 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.”
The rules and template are attached.
Connecticut
The Office of the Healthcare Advocate has taken the lead on public education regarding ACA insurance options. See their website linked here:
Virgin Islands
The U.S. Virgin Islands has received the Consumer Assistance Grant and recently hired three consumer protection officers and opened an office of Insurance Consumer Protection within the Division of Banking and Insurance, Office of the Lieutenant Governor.
The three year grant allows the Division to offer telephone and online support to residents regarding the PPACA implementation as it regards health insurance plans in the territory and provide educational outreach regarding consumer rights and protections.
District of Columbia
This project narrative provides an overview of Pennsylvania’s proposal for the Office of Consumer Information and Insurance Oversight (OCIIO). Pennsylvania intends to use this grant to expand its consumer services and create the consumer assistance program (“CAP”) under the jurisdiction of the Pennsylvania Insurance Department.
District of Columbia
This report, issued by the Community Service Society in New York, provides an overview of the ACA's consumer assistance programs. The report includes recommendations for policymakers to consider as they implement these programs.
District of Columbia
The Kentucky Department of Insurance applied for, and received, a consumer assistance program grant to provide outreach and education to the state.
Here is the state's application, which was submitted in 2010.
District of Columbia
On August 17, 2011 HHS released standards for insurance labeling forms based on input from the NAIC. Attached are two notices of proposed rulemaking as well as the template for the forms.
District of Columbia
This report examines the impact of health reform on Rhode Island and makes recommendations on a number of topics, including: Exchanges, insurance, capacity, public health and delivery systems. Access the report here: http://www.statereforum.org/sites/default/files/healthy_ri_task_force_re...
District of Columbia
This report provides lessons learned from MA that are relevant to national health reform implementation, including: Exchange issues, stakeholder engagement and educating consumers. Access the report here:
http://www.statereforum.org/sites/default/files/lessons_for_national_ref...
Massachusetts
See below for a link to a consumer bulletin issued by the Massachusetts Division of Insurance explaining to consumers what insurance changes federal health reform will bring.
http://www.mass.gov/?pageID=ocaterminal&L=4&L0=Home&L1=Consumer&L2=Insur...
Maine
This presentation highlights Maryland’s various outreach efforts to consumers, businesses, providers, government entities, and others.
Access the presentation here:
http://www.statereforum.org/sites/default/files/100914outreachresourcesp...
Maine
This report contains recommendations related to engaging stakeholders in the implementation process and educating consumers about how health reform affects them.
Access the report here:
http://www.statereforum.org/sites/default/files/md_finalreporteducationw...
District of Columbia
This presentation outlines both short term and long term efforts needed to reach out to and educate consumers. Access the presentation here: http://www.statereforum.org/sites/default/files/mdconsumereducationoutre...
District of Columbia
This presentation summarizes the immediate insurance reforms in the ACA and how they relate to Maryland.
Access the presentation here: http://www.statereforum.org/sites/default/files/md_insurance_market_refo...