The ACA sets new requirements for transparency and disclosure that will give consumers unprecedented access to information about benefits, cost-sharing, and business practices of insurance companies. In addition, this information will help the agencies regulating insurance to identify and crack down on bad behavior.
For example, insurers must provide a summary of benefits to enrollees that uses uniform definitions of insurance and medical terms, describes out-of-pocket charges, and details limitations on coverage. This information must be culturally and linguistically appropriate and in easy-to-understand language. Health plans must also provide information to consumers on the availability of in- and out-of-network providers. In addition, plans must provide a coverage facts label that illustrates examples of an enrollee's likely out-of-pockets costs if they experience an illness or health condition such as breast cancer or pregnancy.
For health plans to be certified and offered in the Exchanges, the ACA requires them to disclose information on business practices, such as medical claims payment policies, financial disclosures, enrollment and disenrollment, the number of claims denied, rating practices, cost-sharing and payments for out-of-network coverage, enrollee rights and other information.