Letter to CCIIO Regarding Draft Summary of Benefits and Coverage

The Association for Community Affiliated Plans (ACAP) respectfully submits comments regarding the draft Summary of Benefits and Coverage (SBC) and Uniform Glossary.

ACAP is an association of 59 not-for-profit and community-based Safety Net Health Plans (SNHPs) located in 24 states. Our member plans provide coverage to 12 million individuals enrolled in Medicaid, the Children’s Health Insurance Program (CHIP) and Medicare Special Needs Plans for dually-eligible individuals. Nationally, ACAP plans serve roughly one-third of all Medicaid managed care enrollees. In addition, 18 of ACAP’s Safety Net Health Plan members have elected to offer qualified health plans (QHPs) in the Marketplaces in 2015.

Summary of ACAP’s Comments

Please find below ACAP’s comments on this rule. ACAP has opted to respond to one aspect of the draft SBC and Uniform Glossary that is particularly relevant to Safety Net Health Plans, rather than to the entire rule. ACAP members participating in the Marketplaces are supportive of the requirements in the draft rule, and have noted that the SBC is a very useful tool for consumers.

Making the SBC Understandable by Average Plan Enrollee. Section 147.200(a)(3)(i) establishes that “the SBC must be presented in a uniform format, use terminology understandable by the average plan enrollee (or, in the case of individual market coverage, the average individual covered under a health insurance policy), not exceed four double-sided pages in length, and not include print smaller than 12-point font.”

ACAP supports these requirements. However, we question whether the SBC template and Uniform Glossary as currently developed are indeed understandable by the average enrollee. ACAP members have substantial experience providing coverage to people with low literacy skills. In order to ensure that critical materials are understandable, many state Medicaid programs require documents to be produced at a sixth grade reading level or lower. Furthermore, one study of 400 Medicaid patients demonstrated that patients with low reading skills experiences more hospitalizations, incurred higher medical costs, had 2 fewer primary care physician visits, and in general experienced poorer compliance with treatment plans than those with higher reading ability.

What is known currently about Marketplace enrollees suggests that the population is in many ways similar to the Medicaid population. Approximately 87 percent of Marketplace enrollees, for example, have low to moderate incomes, which enable them to receive premium tax credits to purchase coverage. Given this, we harbor concerns that many Marketplace enrollees may not find the SBC and Uniform Glossary readable; we agree with other consumer-focused organizations that believe that the text permitted by these rules may exceed the understanding of many individuals, thus rendering this important tool unusable.

ACAP believes that CMS should revise the draft regulation to require the SBC and Uniform Glossary be produced at an accessible reading level. Furthermore, the SBC and Uniform Glossary should also be revised to ensure an accessible reading level for more health care consumers.

ACAP urges CMS to revise the SBC template and Uniform Glossary to ensure they are understandable to individuals at a sixth-grade reading level. In addition, ACAP asks CMS to include in the final regulation a requirement that these documents be produced at an accessible reading level.


ACAP thanks you for your willingness to discuss these issues with us. If you have any additional questions or comments, please do not hesitate to contact Jennifer Babcock (202-204-7518, jbabcock@communityplans.net).


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