Under the Affordable Care Act (ACA)
insurance companies and employers now are required to provide consumers in the private health
insurance market with a brief summary of what a health insurance policy or
employer plan covers, called a Summary of Benefits and Coverage (SBC).
Additionally, consumers will have access to a uniform glossary that defines
insurance and medical terms in standard, consumer-friendly terms.
These tools also will help employers find the best coverage for their
business and employees.
SBC includes a new comparison tool that helps consumers compare coverage
options by showing a standardized sample of what each health plan will cover
for 2 common medical situations. The comparison tool is modeled on the
nutrition facts label required for packaged foods.
SBC will include information about the covered health benefits,
out-of-pocket costs, and the network of providers. The glossary defines terms
commonly used in the health insurance market, such as "deductible"
and "copay," using clear language.
Starting this fall, consumers will receive SBC free of charge and in writing
from their insurance companies or employers. This information can be requested
at any time, but it will also be made available when shopping for, enrolling
in, or renewing coverage. It also will be provided whenever information in SBC
SBC now is available for consumers in the individual health insurance
market. For enrollees in group health plans enrolling during an open enrollment
period, it will be available during the next open enrollment period that
started on or after September 23, 2012. For enrollees who enroll outside of an
open enrollment period, it will be available at the start of the next plan year
that began on or after September 23, 2012.
The Center for Consumer Information
and Insurance Oversight provides examples of SBC,
an SBC template, and the uniform glossary.
Additional information for consumers
is available at healthcare.gov.
If you're not receiving the Foundation
for Physical Therapy's monthly News &
Events e-newsletter, sign up today and stay current with the latest
information on research supported by the Foundation, funding and awards, and
events. The newsletter also provides quick links to information about the
Foundation's Trustees and staff; scholarships, fellowships, and grants; and how
to make a donation.
Visualizing Health Policy, a new monthly feature in JAMA, illustrates how health care costs in the United States have
surged over the past 50 years. The infographic, created by the Kaiser Family
Foundation (KFF), shows how health care spending is unevenly distributed within
the US population, with only half the population accounting for more than 97%
of health care costs; how health care costs are putting pressure on US
families; how the United States spends more per person for health care than
other countries; and how the cost of health insurance premiums has increased in
the past decade for both workers and employers.
infographics are available on KFF's website.
A free booklet available in English and Spanish from
the National Institutes of Health (NIH) aims to teach children and teens how to
avoid sports injuries. Suitable for active kids, parents, and coaches, the
story features teen soccer player Ana, who sprains her knee during a pick-up
game at a family picnic. Ana and her family learn the best way to treat a
sports injury promptly to avoid future complications. This new resource also
offers specific tips on how to keep sports safe for kids and prevent injuries,
such as warming up before exercise and staying hydrated.
Ana's Story is NIH's second fotonovela, a comic-book style publication
popular in the Hispanic/Latino culture that has been used effectively as an
educational tool. Isabel's Story, also available in English and Spanish, teaches about
osteoporosis and bone health.
Free copies of both Ana's Story and Isabel's Story are available to anyone
upon request. To order, contact NIH's National Institute of Arthritis and
Musculoskeletal and Skin Diseases' information clearinghouse at 877/ 226-4267
Tomorrow the Centers for Medicare and Medicaid Services (CMS) will hold a special open door forum, 3:00 pm-4:00 pm ET (conference call only), on the manual medical review of therapy claims. Physical therapists are encouraged to participate in the call, which will provide an opportunity to ask questions about the mandated manual medical
review of therapy services October 1-December 31, 2012, which was enacted by the Middle Class Tax Relief and Job Creation Act of 2012.
CMS will discuss therapy documentation requirements. The therapy cap applies to all Part B outpatient therapy settings and providers including:
Beginning this year, the therapy cap also will apply to therapy services furnished in hospital outpatient departments October 1-December 31, 2012. Before 2012, therapy provided in hospital outpatient departments did not count toward the therapy cap.
Participants may submit questions prior to the special forum to email@example.com.
To participate, call 866/501-5502 and enter conference ID 34261274. (TTY Communications Relay Services are available for people with hearing impairments. For TTY services dial 7-1-1 or 800/855-2880. A relay communications assistant will help.)
A downloadable transcript and audio recording of the forum will be posted to CMS' website.
The Robert Wood Johnson Foundation's
(RWJF) new Data Hub tracks state-level data and allows users to visualize,
customize, and share facts and figures on key health care topics. Users select
a category and an indicator to create a map or rankings report, and can modify
reports as appropriate by payer, income, educational attainment,
race/ethnicity, or timeframe. Data Hub is part of RWJF's commitment to
providing timely, accessible information and evidence to inform health policies
and practices. The online resource establishes a system of priority measures
for monitoring state-level progress toward improving the nation's health and
Being overweight or obese is the
leading medical reason that young adults cannot join the military, with 1 in 4
too overweight to enlist, says a report issued today by Mission:Readiness, a group of more than 300 retired
generals and admirals.
Schools are selling 400 billion
calories of junk food every year—the equivalent of nearly 2 billion candy bars—says
Too Fat to Fight, which calls for stronger standards
for foods and beverages sold at schools.
According to the report, the military
spends over a billion dollars a year on weight-related diseases. "Because
our country has failed to improve fitness and reduce obesity among our youth,
the military has had to work much harder than in the past to recruit and retain
enough qualified men and women who can effectively serve our country," the
This month the Centers for Disease
Control and Prevention (CDC) is highlighting the critical role that schools play in improving the physical activity and dietary and behaviors
of children and adolescents. CDC has synthesized research and best practices
related to promoting healthy eating and physical activity in schools,
culminating in 9 guidelines.
Each of the guidelines is accompanied
by a set of implementation strategies developed to help schools work toward
achieving each guideline. For example, strategies to achieve guideline 4, which
calls for the implementation of a comprehensive physical activity program with high-quality
physical education as the cornerstone, include requiringstudents in grades K-12 to participate
in daily physical education that uses a planned and sequential curriculum and
instructional practices that are consistent with national or state standards
for physical education, providing a substantial percentage of each student's
recommended daily amount of physical activity in physical education class, and
using instructional strategies in physical education that enhance students'
behavioral skills, confidence in their abilities, and desire to adopt and
maintain a physically active lifestyle.