The National Hemophilia Foundation (NHF) will be participating in a Statutory Working Group required by the new healthcare reform law and appointed by the National Association of Insurance Commissioners (NAIC). Sally McCarty, an insurance and advocacy consultant to NHF, has been appointed to the working group as a representative of NHF. The appointment will give the bleeding disorders community a direct say in implementing some important healthcare reform provisions.
The Patient Protection and Affordable Care Act (PPACA) directs the Secretary of Health and Human Services to develop standards for summaries of benefits and coverage explanations distributed to applicants and enrollees in both individual and group health insurance plans. The law requires the secretary to consult with the NAIC, along with “a working group composed of representatives of health insurance-related consumer advocacy organizations, health insurance issuers, healthcare professionals, patient advocates including those representing individuals with limited English proficiency, and other qualified individuals.” NHF and the American Diabetes Association are the only two disease groups on the NAIC’s 19-member working group.
Another section of the new law requires the NAIC to develop criteria for Qualified Health Plans to be included in the American Benefit Exchanges that will be operational in 2014 and to develop a uniform enrollment form to be used by the qualified plans. The enrollment form must “[take] into account criteria that the National Association of Insurance Commissioners develops and submits to the Secretary.”
All of these tasks will be carried out by the NAIC’s Consumer Information Subgroup, in conjunction with the Statutory Working Group. The subgroup will divide its work into two parts: developing standards for the explanations of coverage and benefit summaries, and developing standard definitions. Both groups will focus on transparency and readability for the materials being developed.
To ensure that the subgroup considers issues affecting people with bleeding disorders, we are encouraging members of the community to share their insurance stories. Specifically, we urge you to share your stories if you have been misled by unclear language in an insurance policy, or have received an explanation of benefits (EOB) following a claim that was confusing or otherwise difficult to understand. You can send your comments to firstname.lastname@example.org, or go directly to the NHF Tell Your Story Web page.