Comparing Health Plans Just Got Easier

Have you ever tried to compare health plans? It isn’t easy. Insurance companies design brochures to sell their plans. They have pictures of people holding hands, pushing a child on a swing, smiling in the doctor’s office and just being happy. They highlight everything that is great about the plan and, by the time you get to the chart summarizing the benefits, you would think this is the best insurance plan ever.

Then you look at another plan’s brochure that also makes the plan seem like the best insurance plan ever. But you try to compare the benefits and you aren’t really sure what you are comparing. The brochures use different terms and different formats. You can’t find a description of maternity coverage. You are trying to figure out how all the dollars and percentages add up to actual costs.

Starting today, things are different. That is because plans now have to provide all applicants and enrollees a standard Summary of Benefits and Coverage (called the SBC for short) and a uniform glossary. The Summary is simple to read, short, and provides a standard chart of benefits and coverage examples that every plan must use. The Glossary provides standard definitions of important health insurance terms that impact your coverage.

These new documents are important tools for women shopping for insurance or comparing different employer plans. They are particularly important for women who need maternity coverage. You can now look at an Summary for every plan you are considering and turn to page 7 and compare a “Having a Baby” coverage example for each plan. The coverage example describes typical patient costs for a normal pregnancy and delivery. If you don’t understand a term, you can look it up on the Glossary. For women who have other health needs, there is also a coverage example for “Managing Type 2 Diabetes” that can help you understand how plans cover chronic disease maintenance. Other coverage examples important to women’s health should be required in the future.

Only 12% of health insurance plans offered on the individual market cover maternity benefits. The Summary makes it really easy to understand if the plan provides any maternity coverage and how extensive the coverage is. On page 4 of the Summary, the plan must list patient costs for prenatal and postnatal care and for delivery and any limitations or exceptions.

On this table, the plan must describe what the patient pays when using an in-network (also known as participating) provider. The plan may list a percentage coinsurance, such as 20% of all costs, or a copayment, such as $20 for prenatal visits. There is also a column for information on the use of out-of network (non-participating) providers.  Make sure to look at the final column which will list limitations and exceptions for each benefit!

On page 7, the coverage example described what typical patient costs would be under the plan if there is a normal delivery. This coverage example will help women understand how much the plan generally pays for a normal delivery.

You should know that your costs may be different. You may go to a provider that has higher or lower costs. You may deliver through a c-section or have complications. This coverage example is not meant for you to budget your own medical costs, but to help you compare different plans. For example, it will be really clear if a plan covers no maternity because the top three bullets will look something like this:

• Amount owed to providers: $7,540
• Plan pays: $0
• Patient pays: $7,540

In comparison, a plan that covers maternity with low cost-sharing may look something like this:

• Amount owed to providers: $7,540
• Plan pays: $6,740
• Patient pays: $800

What if a plan does not include maternity coverage, but it does cover complications of pregnancy. Do you know what complications of pregnancy means? The new Uniform Glossary provides a clear definition:

Thanks to the health care law, shopping for health insurance just became a whole lot easier. If you are currently enrolled in coverage, you should be able to call your plan and request the Summary or Glossary at any time. If you are looking for coverage, you should receive the Summary before you enroll in a plan.