DeLauro Health Care Bill Incorporated into House/Senate Reform Legislation

Will make health insurance more transparent, accountable to consumers

Washington, D.C. – Building off of Congresswoman Rosa DeLauro's (CT-3) Informed Consumer Choices in Health Care Act of 2009, the House Committees on Education and Labor, Energy & Commerce, and Ways & Means, as well as the Senate Health, Education, Labor and Pensions Committee, included provisions in their health care reform legislation that would make it easier for consumers to make informed choices about their health insurance coverage.

"Health insurance affects our health and well-being – and our wallets -- more than any consumer product, yet knowing what is in a health insurance policy before we buy it – or when we get sick – is almost impossible for the average consumer," said DeLauro.

"By incorporating provisions of the Informed Consumer Choices in Health Care Act, the House and Senate are helping to bring down the barriers when it comes to informed decisions about our health insurance. I am thrilled that both the House and Senate have included these critical transparency and accountability provisions in their health care reform legislation. Consumers should not have to take a stab in the dark."

On the inclusion of a strong public plan option in the House tri-committee legislation, DeLauro added, "I am also extremely pleased that the House tri-committee legislation maintains a strong public plan option. I firmly believe that a public insurance option is critical to any reform proposal – ensuring competition with private health insurance to bring prices down and an expansion of choice for consumers. It will enable us to achieve savings with preventive care and wellness coverage, expanded computerization of records, and best practices."

The bill released by the House Committees on Education and Labor, Energy & Commerce, and Ways & Means includes strong transparency, accountability, and consumer assistance provisions, including:

Transparency:

• Ensuring that consumers can clearly understand what they will have to pay if they go out of network instead of in-network. (Sec 115)

• Establishing fair marketing, grievance, and appeals practices by health insurers. (Sec 131, 132)

• Requiring health plans to disclose clear, accurate, and timely information such as plan documents, terms and conditions; payment policies; enrollment and disenrollment; the number of claims denials; and other key information. (Sec 133)

• Clarifying information for health care professionals and freeing up time for patients by establishing transparency standards relating to reimbursement arrangements between health plans and providers; (Sec 133)

• Requiring advance notice of plan changes so that consumers get what they pay for during the entire contract period. (Sec 133)

• Providing for standard definitions of insurance and medical terms so that consumers are not surprised by policies that don't mean what they say. (Sec 142) Consumer assistance:

• Health Insurance Ombudsman to assist consumers with complaints, grievances, and requests for information submitted by indivuals, and help consumers make more informed choices of health care coverage. (Sec 144)

• A Consumer Assistance service for exchange-eligible individuals including a toll-free hotline and website to assist consumers in selecting plans

Accountability:

• Provides for strong enforcement of Federal health insurance requirements for all health plans both inside and outside of the Exchange. (Sec 142(b)). Federal health insurance requirements include new rules prohibiting denials based on pre-existing conditions, prohibiting rate discrimination based on gender or health status, as well as existing provisions such as mental health parity and genetic non-discrimination.

Additionally, the Senate HELP Committee approved an amendment to the Affordable Health Care Choices Act designed to require full disclosure to consumers in advance of any changes made to a policy. It would guarantee that insurance companies cannot change or take away coverage once a policy has been issued. And, it would help states establish and support offices of health insurance consumer assistance, which would serve as a resource for consumers who have difficulties with their health insurance.

Connecticut has an Office of the Healthcare Advocate which advocates for patients and their families in their dealings with the health insurance industry. Last year, the office helped consumers recover over $5 million in denied claims.

Specifically, provisions based on DeLauro's Informed Consumer Choices in Health Care Act of 2009, included in the Senate HELP Committee legislation

o Disclosure of Information: Under the amendment, health insurance companies must clearly disclose provisions of coverage concerning the issuer's right to change premiums, co-payments, or other information as determined by the Secretary of HHS. In addition, they must disclose the benefits and premiums available under all health insurance coverage for which an individual or employer is qualified.

This information must be disclosed to individuals or employers as part of the health insurance companies' marketing materials. When a change occurs in the policy, the health insurance company must notify individuals and employers and provide a clear explanation of the change. All of this information must be made available upon the request of an employer or individual.

o Health Insurance Consumer Assistance Grants: Grants will be awarded to states to enable them to establish, expand, or support offices of health insurance consumer assistance, so that consumers always have someone on their side when they have a question or concern about their insurance. Offices of health insurance consumer assistance will receive and respond to inquiries and complaints in a timely fashion. Specifically, the state-designated office of health insurance consumer assistance will—

• Assist with the filing of complaints and appeals;

• Track consumer complaints;

• Educate consumers on their rights and responsibilities with respect to health plans, and;

• Assist consumers with enrollment in a qualified health plan.