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Insurers required to give individual, overall out-of-pocket limits for marketplace plans

Health plans will use the final template beginning April 1, 2017, the first day of the new open enrollment period

Susan Morse, Senior Editor

The federal government has added key enhancements to the summary of benefits and coverage template, and to the uniform glossary, to help consumers better navigate marketplace choices for health insurance, the Center for Medicare and Medicaid Services announced Wednesday.

Under the Affordable Care Act, issuers and health plans are required to provide a brief summary of what their plan covers and the cost sharing responsibility of the consumer.

Plans and issuers are also required to give a comprehensive uniform glossary of commonly used health coverage and medical terms.

"Only when a consumer has a clear understanding of what their plan can do for them as well as what they are responsible for can they feel completely confident in their health plan choice," said Marketplace CEO Kevin Counihan.

The summary of benefits template includes coverage examples that demonstrate the cost sharing amounts for which an individual is responsible in three common medical situations.

Two medical situations, for diabetes care and childbirth, are already on the template. CMS has added a coverage example for a foot fracture, so a consumer understands what a plan covers in an emergency situation.

Changes have also been made to the template to include more explanation of deductibles.

The template requires health plans to address individual and overall out-of-pocket limits.

These improvements reflect input from consumer groups, the National Association of Insurance Commissioners, and other stakeholders, according to CMS.

Health plans and issuers will use the final template beginning on the first day of the first open enrollment period that begins on or after April 1, 2017, CMS said.

Twitter: @SusanJMorse