Health Insurance Consumer Information

(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. 1002 of the Affordable Care Act, concerning health insurance consumer information?

Beginning with fiscal year 2010, the Department of Health and Human Services (HHS) must award grants to eligible states (or to Exchanges operating within a state) to enable the state to establish (or expand) either (1) an office of health insurance consumer assistance or (2) a health insurance ombudsman program (“health insurance consumer program”), in order to provide consumers with assistance in navigating health insurance requirements under federal and state law.

Eligibility requirements. For states to be eligible to receive grants, the health insurance consumer programs must, either directly or in coordination with state health insurance regulators and consumer assistance organizations, respond to consumer inquiries and complaints regarding health insurance requirements under federal and state law. In addition, the state must comply with such additional criteria as the HHS may establish.

Duties of the health insurance consumer programs. The health insurance consumer programs must:

(1) help consumers file health insurance complaints and appeals, including the internal appeals process of a group health plan or health insurance issuer, and provide information about the external appeals process;

(2) collect, track, and quantify problems and inquiries encountered by consumers;

(3) educate consumers on their rights and responsibilities;

(4) assist consumers with enrollment in a group health plan or health insurance coverage; and

(5) resolve consumers’ problems with obtaining premium tax credits under IRC Sec. 36B.

Funding. Funds to be appropriated to the HHS to finance this provision are $30 million for the first fiscal year when the section applies and as needed for the program’s operation in subsequent years.

Data collection. The health insurance consumer programs must collect and report data to the HHS on the types of problems encountered by consumers. The HHS must use the data to identify areas where increased enforcement is necessary, and also must share the information with state insurance regulators and the Secretaries of Labor and of the Treasury.

Effective date. The provision takes effect on the date of enactment (March 23, 2010).

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