Noting that the existing Summary of Benefits and Coverage (SBC) template is incomplete in critical ways, the National Partnership for Women & Families filed comments with the Office of Management and Budget today offering recommendations to improve it. Problems with the SBC, the comments say, include its suggestion that preventive services are restricted to a health care provider’s office or clinic when, in fact, women can obtain services such as breastfeeding support, birth control medications and mammograms outside a provider’s office or clinic; and it significantly underestimates costs associated with childbearing for women who give birth in hospitals.
“The SBC is critical to the success of the health insurance marketplace created by the Affordable Care Act (ACA),” said National Partnership President Debra L. Ness. “Consumers rely on it to compare health plans and choose the one that best meets their needs. It provides more pre-enrollment information than any other document that is readily available to consumers. As such, a consumer-friendly, clear and informative SBC is essential. We are grateful for the opportunity to provide these comments and stand ready to work with the federal government to incorporate these suggestions, so the SBC will do a better job of clarifying what women’s health services each insurance plan will cover.”
Among the National Partnership’s recommendations to improve the SBC:
- Create a new category under “Common Medical Event” for preventive services that directs consumers to a website that provides a comprehensive, updated list of all preventive services covered by each health insurance plan.
- Better inform prospective enrollees about maternity care costs by listing and including in coverage example calculations what each plan would cover for the five most costly services (woman’s professional fees, woman’s facility fee, woman’s anesthesia fee, newborn facility fee and newborn professional fee) commonly associated with childbirth.
- List abortion coverage in the “Common Medical Event” section, and require that the SBC clearly articulate the scope of abortion coverage to give consumers unambiguous, baseline information about their coverage.
The National Partnership’s comment letter is available here.
About the National Partnership
The National Partnership for Women & Families is a nonprofit, nonpartisan advocacy group dedicated to promoting fairness in the workplace, reproductive health and rights, access to quality, affordable health care and policies that help women and men meet the dual demands of work and family. More information is available at NationalPartnership.org.