Insurance Companies and Employers Provide New Summary of Benefits and Coverage
To comply with requirements found in the Affordable Care Act, insurance companies and employers are now providing consumers in the private health insurance market with a brief summary of insurance policy or employer plan coverage, according to the Department of Health and Human Services.
Called the Summary of Benefits and Coverage (SBC), the document includes information about covered health benefits, out-of-pocket costs, and the provider network. The SBC also includes a comparison tool, which is modeled on the Nutrition Facts label required for packaged food. This tool helps consumers compare coverage options by showing a standardized sample of what a health plan will cover for two common medical situations—having a baby and managing type 2 diabetes.
In addition to the SBC, consumers will have access to a uniform glossary that defines insurance and medical terms using common language.
JAMA study shows modest overall savings in ACO PGP demo
Researchers found modest estimates of overall savings associated with the Physician Group Practice (PGP) demo, a five-year demonstration considered a precursor to the Affordable Care Act’s (ACA) Medicare ACO Shared Savings Program, but larger savings among the dually eligible patients. The PGP demo generated $114 in average savings per patient and $532 in savings per dual eligible patient each year, with savings achieved in large part through reductions in hospitalizations, according to a study published Sept. 12 in the Journal of the American Medical Association.
CMS launched the PGP demonstration in 2005 as a collaboration with 10 large medical practices, which included 5,000 physicians and 220,000 Medicare patients.
