According to the Affordable Care Act, all Americans now have right to heath care, no matter what their income is, no matter what their health conditions might be. But there is still work to be done, and numerous states are crafting legislation that will make health insurance marketplaces more transparent while closing the gaps that still allow for discriminatory practices. Here in Connecticut, an important piece of legislation set to do just that see a vote in the coming weeks: Senate Bill 24.
S.B. 24 will require any entity offering health insurance to provide documentation clearly delineating coverage exclusions or restrictions, including those for prescription drugs. Deductibles, out-of-pocket expenses, copayments, and coinsurance must be outlined for each covered benefit. Companies must also indicate if the drug requires any preauthorization, which health care providers and hospitals are considered to be in-network and whether a given drug is covered when dispensed by a physician or clinic.
S.B. 24 will require any entity offering health insurance to post the above information online. This information will also be made available to consumers at the time of health plan enrollment.
The Connecticut Health Insurance Exchange will also be required to post the above information on its website for each qualified health plan sold through the exchange. The Insurance Commissioner will also be required to post helpful links on its website so that consumers can compare and evaluate various health insurance policies.
S.B. 24 will require the Insurance Commissioner to evaluate whether or not any entity offering health insurance is in compliance with anti-discriminatory benefit design. Companies will submit upon request by the Commissioner a plan's given benefits, coverage exclusions, drug formularies and their given tier structures, expenses such as copayments, coinsurance, and deductibles, and any other requested information relevant to the evaluation.
The Insurance Commissioner will report the findings from these evaluations to the General Assembly each year.
It might surprise you that legislation that ensures transparency and practice free from discrimination is not already in place, but the fact of the matter is there is still work to be done to ensure health care consumers are empowered in their choices and protected in their coverage. Learn more about S.B. 24 here, and find more information on how to advocate for your right to health care here.