Empowering Consumers in a New Health Insurance Marketplace

Health insurance reform should include:

■ An insurance “exchange” or “connector,” offering a choice of plans, that will:

√ Limit excessive variations in benefit design so that plans compete more on price and quality

√ Require information on price and quality to be presented in user-friendly formats

√ Include an optimal number of plan choices – not too few and not too many

√ Require plans to provide year-long benefit, price, and provider network stability

√ Protect against marketing abuses and punish insurers that mislead consumers

√ Ensure consumer co-payments for out-of-network care are based on honest, audited data

√ Make consumers fully aware of their rights to register complaints about health plan service, coverage denials, and balance-billing and co-pay problems, and to appeal coverage denials

■ A new Office of Consumer Health Insurance Education and Information that will:

√ Provide general and comparative information about insurance issues and policies using consumer-friendly formats

√ Require standardization of insurance definitions and forms so consumers can easily compare policies on an “apples-to-apples’ basis

√ Require insurers to clearly state (in standardized formats) what’s covered and what’s not in every policy offering, and to estimate out-of-pocket costs under typical treatment scenarios

√ Maintain an insurance information and complaint hotline, and compile federal and state data on insurance complaints and report this data publicly on a Web site

√ Institute and operate quality rating programs of insurance products and services

√ Manage a greatly expanded State Health Insurance and Assistance Program that would provide technical and financial support (through federal grants) to community-based non-profit organizations providing one-on-one insurance counseling to consumers