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Health insurance and more plain English

Itís a broken record but true. Attorneys are dangerous to a consumerís health! When you look at their ability to take ordinary English and make it complicated, there are few people on the planet to equal them. The moment a contract is drafted, the choice of words changes from everyday to jargon. The sentences get longer with more clauses. This is not the type of English ordinary people can read easily. Worse, itís often difficult for people to get hold of the policy before they buy. This is particularly true for the health plans provided by employers. Naturally, in larger companies, thereís probably an in-house attorney who reads the small print and offers advice to the HR Department on whether the plan represents good value for money. But, all too often, none of the employees get to see this plan. The best most can hope for is a summary of the benefits produced by the HR Department ó not necessarily the most reliable source of information about an insurance policy. More importantly, the HR Department rarely explains what the real costs are. Employees find out the hard way on the extent of the cover, the amount of any deductible and the extent of the co-payments required.

You will be pleased to know this is changing, thanks to the Affordable Care Act 2010. Yes, Obamacare really does have some good stuff in it. The rules will require insurance companies and the employers who buy their plans to give employees clear written guidance on those plans. This starts with a simple listing of both what is covered and what is not. In most plans, this information tends to be buried with headline benefits undercut by a later listing of exclusions. Now this should be a simple list. Itís the same with costs. The annual premium must be disclosed together with explanations of what you must pay, particularly if you want to go to consult a doctor not in the network. Perhaps even more importantly, the document must be written in clear English and, to help should you ever want to read the plan itself, there should also be a set of definitions where all the jargon words are explained.

Weíve all just seen what happens to property values when mortgage and other loan documents are not explained to borrowers. They get caught out by the language and many default. Foreclosures follow. Although the consequences to signing up to health plans are not quite so dramatic, you can end up with a poor value-for-money plan and big bills for topping up the care from your own pocket. The insurers are, of course, still complaining. They are even saying the premium rates may have to rise to cover the increased administrative costs to produce the explanatory materials.

All this is due to come into force early in 2012 so, if you are in an employer plan, you should get a better insight into the extent of the cover. If your employer offers a choice of plans, it should also help make a better choice. Whether individual or group, health insurance should not be made more difficult than it needs to be. Thanks to Obamacare, we have one less problem to confront the next time weíre asked to decide whether to join a health insurance plan.


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