The Patient Protection and Affordable Care Act (also known as PPACA or Affordable Care Act) provides consumers with significant new protections, including the ability to appeal decisions by plans to deny coverage of needed services and select an available primary care provider of their choosing.

As part of the law, the The Center for Consumer Information & Insurance Oversight (CCIIO) is helping consumers appeal health plan decisions, understand the Consumer Assistance Program, and more easily understand and evaluate their health insurance choices.

Summary of Benefits & Coverage & Uniform Glossary

Under the Affordable Care Act, health insurers and group health plans will provide the 180 million Americans with private insurance with clear, consistent and comparable information about their health plan benefits and coverage. Specifically, the proposed regulations would ensure consumers have access to two forms that will help them understand and evaluate their health insurance choices. The forms include:

• An easy to understand Summary of Benefits and Coverage
• A uniform glossary of terms commonly used in health insurance coverage such as "deductible" and "co-pay"

You can access the proposed forms under Other Resources below.

Summary of Benefits and Coverage

Under the law, insurance companies and group health plans will provide consumers with a concise document detailing, in plain language, simple and consistent information about health plan benefits and coverage. This Summary of Benefits and Coverage document will help consumers better understand the coverage they have and, for the first time, allow them to easily compare different coverage options. It will summarize the key features of the plan or coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions. People will receive the summary when shopping for coverage, enrolling in coverage, at each new plan year, and within seven days of requesting a copy from their health insurance issuer or group health plan.

Coverage Examples

This Summary of Benefits and Coverage will include a new, standardized health plan comparison tool for consumers: “Coverage Examples,” much like the Nutrition Facts label required for packaged foods. The Coverage Examples would illustrate how a health insurance policy or plan would cover care for common benefits scenarios. Using clear standards and guidelines provided by the Center for Consumer Information and Insurance Oversight (CCIIO), in consultation with the National Guideline Clearinghouse, plans and issuers will simulate claims processing for each scenario so consumers can see an illustration of the coverage they get for their premium dollar under a plan. The examples will help consumers see what how valuable the health plan will be at times when they need the coverage.

Uniform Glossary of Terms

Thanks to the Affordable Care Act, the jargon that makes it impossible to figure out what is covered and how one insurance plan stacks up compared to another will be replaced with terms that are the same across all plans.  Insurance companies and group health plans will be required to make available upon request a uniform glossary of terms commonly used in health insurance coverage such as “deductible” and “co-pay”. To help ensure the document is easily accessible for consumers, the Departments of Health and Human Services (HHS) and Labor will also post the glossary on the new health care reform website, www.HealthCare.gov and www.dol.gov/ebsa/healthreform.

Additional Resources:

• Regulations & Guidance
• Fact Sheets & FAQs
• Letters & News Releases
• Other Resources