Transparency in Coverage

(Note : For the next few weeks, Health Reform Talk will focus on detailed explanations for specific provisions in the new health reform law. Click here for previous post).

So what’s included in Sec. 10101(c) of the Affordable Care Act, concerning transparency in coverage?

Group health plans and health insurance issuers offering group or individual health insurance coverage that are seeking certification as qualified health plans under the Health Insurance Exchanges are required to provide specified information under the transparency in coverage rules. Generally, this required information, involving claims and enrollment, is to be provided to the Health Insurance Exchange, the Department of Health and Human Services (HHS), and the state insurance commissioner and also made available to the general public.

However, the Affordable Care Act further clarifies that a health plan or health coverage which is not offered through a Health Insurance Exchange is obligated to submit the required information only to the HHS and the state insurance commissioner. This information should also be made available to the general public.

Effective date. The provision is effective for plan years beginning on or after the date that is six months after the date of enactment (Sept. 23, 2010).

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